title: Pre-hospital risk factors for inpatient death from severe febrile illness in Malian children.
abstract: BACKGROUND
  Inpatient case fatality from severe malaria remains high in much of sub-Saharan Africa. The majority of these deaths occur within 24 hours of admission, suggesting that pre-hospital management may have an impact on the risk of case fatality.
  
  
  METHODS
  Prospective cohort study, including questionnaire about pre-hospital treatment, of all 437 patients admitted with severe febrile illness (presumed to be severe malaria) to the paediatric ward in Sikasso Regional Hospital, Mali, in a two-month period.
  
  
  RESULTS
  The case fatality rate was 17.4%. Coma, hypoglycaemia and respiratory distress at admission were associated with significantly higher mortality. In multiple logistic regression models and in a survival analysis to examine pre-admission risk factors for case fatality, the only consistent and significant risk factor was sex. Girls were twice as likely to die as boys (AOR 2.00, 95% CI 1.08-3.70). There was a wide variety of pre-hospital treatments used, both modern and traditional. None had a consistent impact on the risk of death across different analyses. Reported use of traditional treatments was not associated with post-admission outcome.
  
  
  CONCLUSIONS
  Aside from well-recognised markers of severity, the main risk factor for death in this study was female sex, but this study cannot determine the reason why. Differences in pre-hospital treatments were not associated with case fatality.
authors: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, United Kingdom.
authors: Merlin L
authors: ML
authors: Willcox
authors: Département de Médecine Traditionnelle, Institut National de Recherche en Santé Publique, Bamako, Mali.
authors: Moussa I
authors: MI
authors: Dicko
authors: CAM Group/Care Assessment Unit, University Institute of Social and Preventive Medicine, Lausanne University, Lausanne, Switzerland.
authors: Bertrand
authors: B
authors: Graz
authors: Ungava Tulattavik Health Centre, Kuujjuaq, Nunavik, Canada.
authors: Mathieu
authors: M
authors: Forster
authors: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, United Kingdom.
authors: Bethany
authors: B
authors: Shinkins
authors: Département de Médecine Traditionnelle, Institut National de Recherche en Santé Publique, Bamako, Mali.
authors: Chiaka
authors: C
authors: Diakite
authors: Aidemet ONG, Bamako, Mali.
authors: Sergio
authors: S
authors: Giani
authors: Department of Plant Medicine, University of Geneva, Geneva, Switzerland.
authors: Jacques
authors: J
authors: Falquet
authors: Département de Médecine Traditionnelle, Institut National de Recherche en Santé Publique, Bamako, Mali; Faculty of Pharmacy, Université des Sciences, Techniques et Technologies de Bamako, Bamako, Mali.
authors: Drissa
authors: D
authors: Diallo
authors: Department of Paediatrics, Sikasso Regional Hospital, Sikasso, Mali.
authors: Eugène
authors: E
authors: Dembélé
mesh_terms: D002648:Child; D046688:Child Mortality; D002675:Child, Preschool; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007297:Inpatients / Q000706:statistics & numerical data; D008288:Malaria / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D008302:Mali; D012307:Risk Factors; D012737:Sex Factors