title: Severe falciparum malaria in Gabonese children: clinical and laboratory features.
abstract: BACKGROUND
  Malaria continues to claim one to two million lives a year, mainly those of children in sub-Saharan Africa. Reduction in mortality depends, in part, on improving the quality of hospital care, the training of healthcare workers and improvements in public health. This study examined the prognostic indicators of severe falciparum malaria in Gabonese children.
  
  
  METHODS
  An observational study examining the clinical presentations and laboratory features of severe malaria was conducted at the Centre Hospitalier de Libreville, Gabon over two years. Febrile children aged from 0 to 10 years with Plasmodium falciparum infection and one or more features of severe malaria were enrolled.
  
  
  RESULTS
  Most children presenting with severe falciparum malaria were less than 5 years (92.3% of 583 cases). Anaemia was the most frequent feature of severe malaria (67.8% of cases), followed by respiratory distress (31%), cerebral malaria (24%) hyperlactataemia (16%) and then hypoglycaemia (10%). Anaemia was more common in children under 18 months old, while cerebral malaria usually occurred in those over 18 months. The overall case fatality rate was 9%. The prognostic indicators with the highest case fatality rates were coma/seizures, hyperlactataemia and hypoglycaemia, and the highest case fatality rate was in children with all three of these features.
  
  
  CONCLUSIONS
  Prompt and appropriate, classification and treatment of malaria helps identify the most severely ill children and aids early and appropriate management of the severely ill child.
authors.affiliation: Department of Parasitology, Mycology and Tropical Medicine, Faculty of Medicine, University of Health Sciences (USS), Libreville, Gabon. dzeingarnaud@yahoo.fr <dzeingarnaud@yahoo.fr>
authors.forename: Arnaud
authors.initials: A
authors.lastname: Dzeing-Ella
authors.forename: Pascal C
authors.initials: PC
authors.lastname: Nze Obiang
authors.forename: Rose
authors.initials: R
authors.lastname: Tchoua
authors.forename: Timothy
authors.initials: T
authors.lastname: Planche
authors.forename: Béatrice
authors.initials: B
authors.lastname: Mboza
authors.forename: Monique
authors.initials: M
authors.lastname: Mbounja
authors.forename: Ulrich
authors.initials: U
authors.lastname: Muller-Roemer
authors.forename: Joseph
authors.initials: J
authors.lastname: Jarvis
authors.forename: Eric
authors.initials: E
authors.lastname: Kendjo
authors.forename: Edouard
authors.initials: E
authors.lastname: Ngou-Milama
authors.forename: Peter G
authors.initials: PG
authors.lastname: Kremsner
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Krishna
authors.forename: Maryvonne
authors.initials: M
authors.lastname: Kombila
mesh_terms: D017677:Age Distribution; D000740:Anemia / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D005681:Gabon / Q000453:epidemiology; D006801:Humans; D007003:Hypoglycemia / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D007223:Infant; D007231:Infant, Newborn; D007773:Lactates / Q000097:blood; D016015:Logistic Models; D016779:Malaria, Cerebral / Q000453:epidemiology / Q000401:mortality; D016778:Malaria, Falciparum / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D009422:Nervous System Diseases / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D018512:Parasitemia / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D013921:Thrombocytopenia / Q000209:etiology / Q000401:mortality
chemical_list: D007773:Lactates