Pattern of malaria in hospitalized children in Khartoum state

Malaria remains a major health problem in Sudan with significant morbidity and mortality particularly in children. We prospectively studied children with malaria admitted to an Emergency Department in Khartoum (August-November 2014). Malaria diagnosis was based on a positive blood smear and rapid diagnostic test. The aim was to study the clinical and laboratory features and short-term outcome of malaria among hospitalized children. Data collected from 112 children (males; 56.3%) who fulfilled the criteria for diagnosis of malaria of whom 72.3% had severe malaria and 27.7% uncomplicated malaria (UM). The mean age was 69.2 ± 54.5 months. Hyperparasitemia was detected in 53% of positive blood smears. Plasmodium falciparum was detected in 69.4%, P. vivax in 26.5%, and mixed species in 4.1%. The risk of severe malaria was significantly higher in patients with hyperparasitemia and P. vivax infection (P = 0.001 and P = 0.014 respectively). Severe malaria cases had significantly higher prevalence of thrombocytopenia and lower mean platelet count than those with UM, P = 0.001 each. Serious complications of severe malaria were cerebral malaria, severe malaria anaemia and acute kidney injury (AKI). The overall case fatality rate was 5.3% and that from severe disease was 4.9%. All deaths were among <60 months-olds and were due to P. falciparum infection with AKI being the only significant risk factor for death (P = 0.045). In Khartoum state, UM is still an important cause of morbidity in children. P. vivax has emerged as a causative species of severe malaria. The lower mortality rate of malaria probably reflects improvement in health care.