Life-threatening malaria in African children: a prospective study in a mesoendemic urban setting.
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.
Ranque
Stéphane
S
Immunology and Genetics of Parasitic Diseases, Faculty of Medicine, Université de la Méditerrané, Marseilles, France. stephane.ranque@ap-hm.fr
Poudiougou
Belco
B
Traoré
Abdoulaye
A
Keita
Modibo
M
Oumar
Aboubacar A
AA
Safeukui
Innocent
I
Marquet
Sandrine
S
Cabantous
Sandrine
S
Diakité
Mahamadou
M
Mintha
Daouda
D
Cissé
Mahamadou B
MB
Keita
Marouf M
MM
Dessein
Alain J
AJ
Doumbo
Ogobara K
OK
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