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Predictors of severity of illness on presentation in children with cerebral malaria
G F Mabeza1, V M Moyo, P E Thuma
1Macha Mission Hospital, Choma, Zambia.
Insights
Chloroquine treatment in children with cerebral malaria correlated with deeper coma and severe anemia, suggesting widespread resistance. Early treatment is crucial, but chloroquine resistance complicates public health efforts.
Area of Science:
- * Malariology
- * Pediatric Infectious Diseases
- * Public Health
Background:
- * Cerebral malaria is a severe complication of Plasmodium falciparum infection in children.
- * Understanding factors associated with disease severity is crucial for effective management and public health strategies.
- * Chloroquine resistance in malaria parasites poses a significant challenge to treatment efficacy.
Purpose of the Study:
- * To analyze presenting features of children with cerebral malaria.
- * To determine clinical factors correlating with coma severity and anemia.
- * To investigate the impact of chloroquine use on malaria severity in a Zambian community.
Main Methods:
- * Retrospective analysis of 195 children with cerebral malaria from southern Zambia (1992-1993).
- * Data collected included coma depth (Blantyre Coma Scale), hematocrit levels, fever duration, splenomegaly, and hypoglycaemia.
- * Correlation analysis between clinical features, treatment history (chloroquine), and parasite counts.
Main Results:
- * Deep coma was associated with longer pre-presentation coma duration and prior chloroquine treatment.
- * Severe anemia (<18% hematocrit) was linked to younger age, longer fever duration, splenomegaly, hypoglycemia, and chloroquine use.
- * Peripheral blood parasite counts did not correlate with coma depth or anemia severity.
Conclusions:
- * Widespread chloroquine use in the study area likely contributed to drug resistance and severe malaria complications.
- * Despite early consultations, chloroquine resistance undermines treatment effectiveness.
- * Effective public health interventions for severe malaria are hindered by high rates of chloroquine resistance.
Abstract:
The presenting features of 195 children with cerebral malaria were analysed to determine which correlated with severity of coma and anaemia. The children, who came from a single community in southern Zambia, were enrolled in an ongoing blinded drug trial in 1992 and 1993. Children with deep coma (scoring 0-2) had significantly longer duration of coma before presentation (P = 0.019) and were more likely to have been treated with chloroquine (P = 0.022) than children with light coma (scoring 3 or 4 on the Blantyre coma scale). Children with severe anaemia (haematocrit < 18%) were younger (P = 0.005), had been febrile longer (P = 0.005), had splenomegaly (P < 0.005) and hypoglycaemia (P < 0.008) more often and were more likely to have been treated with chloroquine (P < 0.005) than those without severe anaemia. The counts of asexual parasites in the peripheral blood were not significantly correlated with depth of coma or severity of anaemia. The observed widespread and uncontrolled use of chloroquine has probably led to the development of resistant malaria and of many severe complications despite early consultation. While early treatment of febrile illnesses in young children and immediate medical attention for altered consciousness must be emphasized in the community approach to severe malaria, our data indicate that effective public health measures will be difficult to develop in the face of a high prevalence of chloroquine resistance.