Severe P. falciparum malaria in Kenyan children: evidence for hypovolaemia.
BACKGROUND
The role of volume resuscitation in severe Plasmodium falciparum malaria is controversial.


OBJECTIVE
To examine the role of hypovolaemia in severe childhood malaria.


METHODS
Retrospective review.


METHODS
We studied 515 children admitted with severe malaria to a high-dependency unit (HDU) in Kilifi, Kenya. On admission to the HDU, children underwent a further assessment of vital signs and a standard clinical examination.


RESULTS
Factors associated with a fatal outcome included deep breathing or acidosis (base excess below -8), hypotension (systolic blood pressure <80 mmHg), raised plasma creatinine (>80 micro mol/l), low oxygen saturation (<90%), dehydration and hypoglycaemia (<2.5 mmol/l). Shock was present in 212/372 (57%) children, of whom 37 (17.5%) died, and was absent in 160, of who only 7 (4.4%) died (chi(2) = 14.9; p = 0.001).


CONCLUSIONS
Impaired tissue perfusion may play a role in the mortality of severe malaria. Moreover, volume resuscitation, an important life-saving intervention in children with hypovolaemia, should be considered in severe malaria with evidence of impaired tissue perfusion.
Maitland
K
K
Centre for Geographic Medicine Research, Coast, KEMRI/Wellcome Trust Unit, P.O. Box 230, Kilifi, Kenya. kmaitland@kilifi.mimcom.net
Levin
M
M
English
M
M
Mithwani
S
S
Peshu
N
N
Marsh
K
K
Newton
C R J C
CR
D000138:Acidosis / Q000188:drug therapy* / Q000209:etiology*; D001803:Blood Transfusion / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D005440:Fluid Therapy / Q000379:methods; D006801:Humans; D020896:Hypovolemia / Q000150:complications* / Q000188:drug therapy*; D007223:Infant; D007231:Infant, Newborn; D007630:Kenya / Q000453:epidemiology; D016778:Malaria, Falciparum / Q000150:complications* / Q000401:mortality; D008297:Male; D012189:Retrospective Studies; D015996:Survival Rate