title: Severe malaria in children in Yemen: two site observational study.
abstract: OBJECTIVE
  To assess the burden of malaria on health services, describe the clinical presentation of severe malaria in children, and identify factors associated with mortality by means of a prospective observational study.
  
  
  METHODS
  Two public hospitals in Taiz (mountain hinterland) and Hodeidah (coastal plain), Yemen.
  
  
  METHODS
  Children aged 6 months to 10 years.
  
  
  RESULTS
  Of 12,301 paediatric admissions, 2071 (17%) were for suspected severe malaria. The proportion of such admissions varied according to the season (from 1% to 40%). Falciparum malaria was confirmed in 1332 children; 808 had severe disease as defined by the World Health Organization. Main presentations were respiratory distress (322/808, 40%), severe anaemia (291/800, 37%), and cerebral malaria (60/808, 8%). Twenty two of 26 children who died had a neurological presentation. No deaths occurred in children with severe anaemia but no other signs of severity. In multivariate analysis, a Blantyre coma score < or = 2, history of fits, female sex, and hyperlactataemia predicted mortality; severe anaemia, respiratory distress, and hyperparasitaemia were not significant predictors of mortality.
  
  
  CONCLUSIONS
  Severe malaria puts a high burden on health services in Yemen. Although presentation is similar to African series, some important differences exist. Case fatality is higher in girls.
authors.affiliation: Faculty of Medicine and Health Sciences, Sana'a University, PO Box 13078, Sana'a, Yemen. a_m_altaiar@yahoo.com
authors.forename: Abdullah
authors.initials: A
authors.lastname: Al-Taiar
authors.forename: Shabbar
authors.initials: S
authors.lastname: Jaffar
authors.forename: Ali
authors.initials: A
authors.lastname: Assabri
authors.forename: Molham
authors.initials: M
authors.lastname: Al-Habori
authors.forename: Ahmed
authors.initials: A
authors.lastname: Azazy
authors.forename: Nagiba
authors.initials: N
authors.lastname: Al-Mahdi
authors.forename: Khaled
authors.initials: K
authors.lastname: Ameen
authors.forename: Brian M
authors.initials: BM
authors.lastname: Greenwood
authors.forename: Christopher J M
authors.initials: CJ
authors.lastname: Whitty
mesh_terms: D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008288:Malaria / Q000453:epidemiology*; D008297:Male; D015006:Yemen / Q000453:epidemiology