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Severe malaria in children in Papua New Guinea
S J Allen1, A O'Donnell, N D Alexander
1Institute of Molecular Medicine, John Radcliffe Hospital, Oxford, UK.
Insights
Severe falciparum malaria in children presents with anemia and coma. High plasma lactate levels are the main predictor of death, highlighting the need for early acidosis management.
Area of Science:
- Pediatrics
- Infectious Diseases
- Malariology
Background:
- Severe falciparum malaria poses a significant threat to children globally.
- Understanding clinical features and mortality risk factors is crucial for effective treatment.
Purpose of the Study:
- To investigate the clinical manifestations of severe falciparum malaria in children.
- To identify risk factors associated with mortality in pediatric malaria cases.
Main Methods:
- A study of 489 children admitted with malaria to Madang Hospital, Papua New Guinea.
- Analysis of clinical features, including severe anemia and coma.
- Statistical analysis to determine predictors of mortality, such as plasma lactate, creatinine, and bicarbonate levels.
Main Results:
- Severe anemia (22%) and coma (16%) were the most common severe malaria manifestations.
- Mortality rate was 3.5%, with most deaths occurring within 12 hours of admission.
- High plasma lactate (> or = 5 mmol/l) was the major predictor of death, followed by raised plasma creatinine and decreased plasma bicarbonate.
Conclusions:
- While clinical features of severe malaria in Papua New Guinean children resemble those in African children, mortality rates were lower.
- Acidosis, indicated by high plasma lactate and low bicarbonate, is a critical factor in pediatric malaria mortality.
- Early recognition and treatment of acidosis in healthcare settings are essential for improving outcomes in severe malaria.
Abstract:
The clinical features of severe falciparum malaria and risk factors for mortality were studied in 489 children admitted with malaria to Madang Hospital, Papua New Guinea. The most common severe manifestations of malaria were severe anaemia (22%) and coma (16%). Children with severe anaemia were younger than those with coma (median age 2.2 vs. 3.7 years) and had been ill for longer before admission (median 7 vs. 4 days, respectively). Although the clinical features of coma in Madang children with malaria resembled closely those reported in African children, mortality was lower (8% vs. 17-25%, respectively). Overall, 17 (3.5%) children died, most within 12 h of admission. A high level of plasma lactate (> or = 5 mmol/l) was common (20%) and was the major predictor of death in multiple regression analysis. Raised plasma creatinine and decreased plasma bicarbonate were also independent predictors of mortality. Coma was not predictive of death, although a high proportion of children with profound coma died. Investigation of the causes of acidosis in children with malaria is a high research priority. In view of the short time interval between admission and death in many children, emphasis must be placed on the prevention or early recognition and treatment of acidosis in the district health clinic as well as the central hospital.