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Severe P. falciparum malaria in Kenyan children: evidence for hypovolaemia
K Maitland1, M Levin, M English
1Centre for Geographic Medicine Research, Coast, KEMRI/Wellcome Trust Unit, P.O. Box 230, Kilifi, Kenya. kmaitland@kilifi.mimcom.net
Insights
Volume resuscitation may be crucial for children with severe malaria and signs of poor tissue perfusion. This intervention is vital for managing hypovolaemia and improving survival rates in pediatric malaria cases.
Area of Science:
- Pediatric Infectious Diseases
- Critical Care Medicine
- Malariology
Background:
- The management of severe Plasmodium falciparum malaria, particularly the role of fluid resuscitation, remains a subject of debate.
- Understanding the impact of hypovolaemia (low blood volume) is critical in severe childhood malaria.
Purpose of the Study:
- To investigate the significance of hypovolaemia in severe pediatric malaria cases.
- To identify factors associated with mortality in children with severe malaria.
Main Methods:
- A retrospective review of 515 children admitted to a high-dependency unit (HDU) in Kilifi, Kenya, with severe malaria.
- Assessment included vital signs, clinical examination, and evaluation of factors like acidosis, hypotension, and dehydration.
Main Results:
- Factors linked to fatal outcomes included acidosis, hypotension, elevated creatinine, low oxygen saturation, dehydration, and hypoglycemia.
- Children in shock had a significantly higher mortality rate (17.5%) compared to those without shock (4.4%).
Conclusions:
- Impaired tissue perfusion is a likely contributor to mortality in severe malaria.
- Volume resuscitation should be strongly considered for children with severe malaria exhibiting signs of impaired tissue perfusion and hypovolaemia.
Background:
The role of volume resuscitation in severe Plasmodium falciparum malaria is controversial.
Aim:
To examine the role of hypovolaemia in severe childhood malaria.
Study Design:
Retrospective review.
Methods:
We studied 515 children admitted with severe malaria to a high-dependency unit (HDU) in Kilifi, Kenya. On admission to the HDU, children underwent a further assessment of vital signs and a standard clinical examination.
Results:
Factors associated with a fatal outcome included deep breathing or acidosis (base excess below -8), hypotension (systolic blood pressure <80 mmHg), raised plasma creatinine (>80 micro mol/l), low oxygen saturation (<90%), dehydration and hypoglycaemia (<2.5 mmol/l). Shock was present in 212/372 (57%) children, of whom 37 (17.5%) died, and was absent in 160, of who only 7 (4.4%) died (chi(2) = 14.9; p = 0.001).
Discussion:
Impaired tissue perfusion may play a role in the mortality of severe malaria. Moreover, volume resuscitation, an important life-saving intervention in children with hypovolaemia, should be considered in severe malaria with evidence of impaired tissue perfusion.
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