Severe falciparum malaria in Gabonese children: clinical and laboratory features.
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.
Dzeing-Ella
Arnaud
A
Department of Parasitology, Mycology and Tropical Medicine, Faculty of Medicine, University of Health Sciences (USS), Libreville, Gabon. dzeingarnaud@yahoo.fr <dzeingarnaud@yahoo.fr>
Nze Obiang
Pascal C
PC
Tchoua
Rose
R
Planche
Timothy
T
Mboza
Béatrice
B
Mbounja
Monique
M
Muller-Roemer
Ulrich
U
Jarvis
Joseph
J
Kendjo
Eric
E
Ngou-Milama
Edouard
E
Kremsner
Peter G
PG
Krishna
Sanjeev
S
Kombila
Maryvonne
M
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
D007773:Lactates