title: Life-threatening malaria in African children: a prospective study in a mesoendemic urban setting.
abstract: BACKGROUND
  The population exposed to malaria within African cities has steadily increased. However, comprehensive data on life-threatening malaria features and risk factors in children from urban areas with seasonal malaria transmission, such as in Bamako (Mali), are lacking.
  
  
  METHODS
  Children admitted to the Gabriel Touré Hospital in Bamako with severe malarial anemia (SMA) and/or cerebral malaria (CM) were prospectively included in the study. Indicators of either SMA or CM were analyzed using logistic regression; and death hazard ratios (HRs) were estimated through survival analysis.
  
  
  RESULTS
  The study included 455 children: 66% presented with CM, 34% with SMA, 3% with hypoglycemia (HG); 5% with dehydration; 17% with respiratory distress (RD); 25% with splenomegaly; and 92% with hepatomegaly. The children with CM were older than those with SMA. CM was more often associated with dehydration, HG, and RD, whereas SMA was more often associated with splenomegaly. The overall case fatality rate was 16%, and 94% of the children who died had CM. HG [HR: 2.37; 95% confidence interval (CI): 1.04-5.39; P = 0.040], RD (HR: 4.23; 95% CI: 2.46-7.30; P < 10(-6)) and a deep coma with a Blantyre score of less than 3 (HR: 6.78, 95% CI: 2.43-18.91; P < 10(-3)), were all independent predictors of death.
  
  
  CONCLUSIONS
  These findings delineate the patterns of severe malaria in children in a West African mesoendemic urban setting. They validate practicable prognostic indicators of life-threatening malaria for use in the limited facilities available in African health centers and provide a frame of reference for further research addressing life-threatening malaria in this setting.
authors.affiliation: Immunology and Genetics of Parasitic Diseases, Faculty of Medicine, Université de la Méditerrané, Marseilles, France. stephane.ranque@ap-hm.fr
authors.forename: Stéphane
authors.initials: S
authors.lastname: Ranque
authors.forename: Belco
authors.initials: B
authors.lastname: Poudiougou
authors.forename: Abdoulaye
authors.initials: A
authors.lastname: Traoré
authors.forename: Modibo
authors.initials: M
authors.lastname: Keita
authors.forename: Aboubacar A
authors.initials: AA
authors.lastname: Oumar
authors.forename: Innocent
authors.initials: I
authors.lastname: Safeukui
authors.forename: Sandrine
authors.initials: S
authors.lastname: Marquet
authors.forename: Sandrine
authors.initials: S
authors.lastname: Cabantous
authors.forename: Mahamadou
authors.initials: M
authors.lastname: Diakité
authors.forename: Daouda
authors.initials: D
authors.lastname: Mintha
authors.forename: Mahamadou B
authors.initials: MB
authors.lastname: Cissé
authors.forename: Marouf M
authors.initials: MM
authors.lastname: Keita
authors.forename: Alain J
authors.initials: AJ
authors.lastname: Dessein
authors.forename: Ogobara K
authors.initials: OK
authors.lastname: Doumbo
mesh_terms: D000293:Adolescent; D000740:Anemia / Q000469:parasitology*; D002648:Child; D002675:Child, Preschool; D019353:Endemic Diseases; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016779:Malaria, Cerebral / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D008302:Mali / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D012621:Seasons; D014505:Urban Population