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Published on: May 16, 2013
Severe malaria
1Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. nickw@tropmedres.ac.
Insights
Severe malaria is a leading cause of childhood death in tropical regions. Improving diagnosis with blood smear tests and treating suspected cases with artesunate and antibiotics can significantly reduce mortality.
Area of Science:
- Tropical Medicine
- Infectious Diseases
- Pediatrics
Background:
- Severe malaria is a critical medical emergency and a primary cause of preventable childhood mortality in tropical nations.
- Despite its significance, international bodies and policymakers are increasingly unaware of severe malaria, leading to its neglect in global health initiatives.
- In sub-Saharan Africa, clinical overdiagnosis of severe malaria is prevalent, with conditions like sepsis often misidentified.
Purpose of the Study:
- To highlight the diagnostic challenges and mortality associated with severe malaria.
- To emphasize the need for improved diagnostic accuracy and timely treatment in severe malaria cases.
- To advocate for increased global attention and investment in combating severe malaria.
Main Methods:
- Review of diagnostic practices and outcomes in severe malaria cases.
- Analysis of the impact of misdiagnosis on mortality rates.
- Evaluation of established diagnostic tests like thin blood smear and full blood count.
- Assessment of treatment strategies including artesunate and broad-spectrum antibiotics.
Main Results:
- Approximately one-third of children diagnosed with severe malaria in sub-Saharan Africa are misdiagnosed, often having sepsis as the underlying cause.
- These misdiagnosed children experience high mortality, contributing significantly to deaths attributed to severe malaria.
- Simple diagnostic tests, such as thin blood smear examination and full blood count, enhance diagnostic specificity and prognostic assessment.
- Early intervention with artesunate and broad-spectrum antibiotics shows potential to decrease global malaria mortality.
Conclusions:
- Accurate diagnosis of severe malaria is crucial, as many cases are misdiagnosed, particularly with sepsis.
- Wider implementation of simple diagnostic tests like blood smears and full blood counts is recommended.
- Prompt administration of artesunate and broad-spectrum antibiotics for suspected severe malaria can substantially reduce child mortality in endemic areas.
Abstract:
Severe malaria is a medical emergency. It is a major cause of preventable childhood death in tropical countries. Severe malaria justifies considerable global investment in malaria control and elimination yet, increasingly, international agencies, funders and policy makers are unfamiliar with it, and so it is overlooked. In sub-Saharan Africa, severe malaria is overdiagnosed in clinical practice. Approximately one third of children diagnosed with severe malaria have another condition, usually sepsis, as the cause of their severe illness. But these children have a high mortality, contributing substantially to the number of deaths attributed to 'severe malaria'. Simple well-established tests, such as examination of the thin blood smear and the full blood count, improve the specificity of diagnosis and provide prognostic information in severe malaria. They should be performed more widely. Early administration of artesunate and broad-spectrum antibiotics to all children with suspected severe malaria would reduce global malaria mortality.
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