The Determinants of Fatal Outcomes during Severe Malaria in Children at the HKM University Teaching Hospital of Cotonou-Benin

Abstract

Introduction: Malaria particularly affects children in sub-Saharan African countries. This study aimed to investigate the factors associated with death in cases of severe childhood malaria to better understand the determinants of death in these children. Patients and Methods: This cohort, descriptive and analytical study was conducted from April 1 to August 15, 2015, at the CNHU-HKM pediatric clinic in Cotonou. Recruitment was exhaustive for all patients under 15 years of age who were admitted for severe malaria, as confirmed by thick smear microscopy. Results: Among the 1774 admitted patients, 449 had severe malaria caused by Plasmodium falciparum (i.e., a hospital frequency of 25.31%).The age group most affected consisted of children younger than 60 months of age (73%); female predominance was noted. The lethality rate of malaria was 13.1% (n = 59). The factors associated with death were coma (p = 0.032), poor convulsive status epilepticus (p = 0.08) and bacterial co-infection by gram negative bacteria (p = 0.021) with respectively correlations coefficient of 0.003, 3.940 and 2.424. Conclusion: Reduction of the malaria mortality rates in Benin hospitals will depend on appropriate management of poor prognostic factors, such as coma, bacterial co-infection and convulsive illness.

Severe malaria burden, clinical spectrum and outcomes at Apac district hospital, Uganda: a retrospective study of routine health facility-based data

“…Another study in Ghana reported a mortality of 11.2% [ 17 ]. Other studies found with high incidences of death include a study on determinants of fatal outcomes of severe malaria in children in Cotonou-Benin that reported a mortality of 13.1% mortality [ 26 ]. Furthermore, a study on SM and risk factors for mortality in the Democratic Republic of Congo that reported even higher rates of 28.3% [ 27 ].…”

“…This study reports haemoglobinuria as risk factors for death, but is not frequently reported in other series outside of studies in Eastern Uganda [ 14 , 28 ]. The commonly reported predictors of mortality in SM include coma and convulsions [ 20 , 26 , 27 ], malnutrition [ 17 , 27 ], cerebral malaria [ 21 , 22 ], and hypoglycaemia [ 17 ].…”

Malaria Case Fatality Rate among Children under Five in Burkina Faso: An Assessment of the Spatiotemporal Trends Following the Implementation of Control Programs

“…Indeed, it has been reported that in severe malaria, neurological manifestations appear within the first 12 h of admission [63] and is fatal without treatment [64]. Severe malaria treatment implies, in addition, supportive care to control complications of especially poor prognosis factors such as severe anemia, respiratory distress, bacterial co-infections and acute renal failure [65][66][67][68][69][70]. Blood, oxygen, dialysis and mechanical ventilation [71] may be necessary for an appropriate treatment of severe malaria.…”

Faktor-faktor Prediktor Luaran Malaria Berat pada Anak

“…Secara signifikan faktor prediktor kematian yang kuat ialah koma dan kejang berulang. 9,18 Malaria serebral didefinisikan dengan Blantyre coma scale (BCS) ≤2 dengan berapapun densitas parasitnya. Koma (BCS<3) berhubungan dengan peningkatan risiko kematian.…”

“…12 Hipoglikemik secara bermakna dan independen berhubungan dengan luaran atau hasil yang buruk termasuk kematian. 14,18 Prostrasi memiliki hubungan bermakna dengan kematian. 14 Prostrasi didefinisikan dengan kelemahan generalisata yang ditandai dengan ketidakmampuan seseorang untuk duduk maupun minum tanpa bantuan.…”