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Mortality patterns and site heterogeneity of severe malaria in African children
Eric Kendjo1, Tsiri Agbenyega, Kalifa Bojang
1Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon.
Insights
Predicting mortality in severe malaria in African children varies by hospital site. Early mortality prediction showed the most consistency across locations, unlike intermediate and late mortality predictions.
Area of Science:
- Pediatrics
- Infectious Diseases
- Epidemiology
Background:
- Severe Plasmodium falciparum malaria poses a significant threat to children in sub-Saharan Africa.
- Understanding mortality patterns and predictors is crucial for improving patient outcomes.
Purpose of the Study:
- To assess the heterogeneity of early, intermediate, and late mortality prediction in children with severe malaria across different hospital sites in sub-Saharan Africa.
Main Methods:
- Analysis of medical records from 26,036 children with severe Plasmodium falciparum malaria across six research centers (2000-2005).
- Comparison of demographic, clinical, and laboratory data between children who died at different time points (early, intermediate, late) and survivors.
- Identification of independent predictors for mortality at different time intervals and across various sites.
Main Results:
- Overall mortality was 4.3% (1,129 children).
- Median time to death varied significantly between sites, from 8 hours to 40 hours.
- Deep breathing, prostration, and hypoglycemia were consistent predictors of early, intermediate, and late mortality across all sites. Site-specific predictors for intermediate and late mortality varied considerably.
Conclusions:
- Significant site heterogeneity exists in predicting mortality for severe malaria in African children.
- Early mortality prediction demonstrates the highest consistency across different hospital sites compared to intermediate and late mortality.
Background:
In this study we aimed to assess site heterogeneity of early, intermediate, and late mortality prediction in children with severe Plasmodium falciparum malaria in sub-Saharan Africa.
Methods:
Medical records of 26,036 children admitted with severe Plasmodium falciparum malaria in six hospital research centers between December 2000 to May 2005 were analyzed. Demographic, clinical and laboratory data of children who died within 24 hours (early), between 24 and 47 hours (intermediate) and thereafter (48 hours or later, late mortality) were compared between groups and survivors.
Results:
Overall mortality was 4·3% (N = 1,129). Median time to death varied across sites (P<0·001), ranging from 8 h (3 h-52 h) in Lambaréné to 40 h (10 h-100 h) in Kilifi. Fifty-eight percent of deaths occurred within 24 hours and intermediate and late mortality rate were 19% and 23%, respectively. Combining all sites, deep breathing, prostration and hypoglycemia were independent predictors for early, intermediate and late mortality (P<0·01). Site specific independent predictors for early death included prostration, coma and deep breathing at all sites (P<0·001). Site specific independent predictors for intermediate and late death largely varied between sites (P<0·001) and included between 1 and 7 different clinical and laboratory variables.
Conclusion:
Site heterogeneity for mortality prediction is evident in African children with severe malaria. Prediction for early mortality has the highest consistency between sites.
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