title: Hypoxemia predicts death from severe falciparum malaria among children under 5 years of age in Nigeria: the need for pulse oximetry in case management.
abstract: BACKGROUND
  Oxygen saturation is a good marker for disease severity in emergency care. However, studies have not considered its use in identifying individuals infected with Plasmodium falciparum at risk of deaths.
  
  
  OBJECTIVE
  To investigate the prevalence and predictive value of hypoxaemia for deaths in under-5s with severe falciparum malaria infection.
  
  
  METHODS
  Oxygen saturation was prospectively measured alongside other indicators of disease severity in 369 under-5s admitted to a tertiary hospital in Nigeria. Participants were children in whom falciparum malaria parasitaemia was confirmed with blood film microscopy in the presence of any of the World Health Organization-defined life-threatening features for malaria.
  
  
  RESULTS
  Overall mortality rate was 8.1%. Of the 16 indicators of the disease severity assessed, hypoxaemia (OR=7.54; 95% CI=2.80, 20.29), co-morbidity with pneumonia (OR=19.27; 95% CI=2.87, 29.59), metabolic acidosis (OR=6.21; 95% CI=2.21, 17.47) and hypoglycaemia (OR=19.71; 95% CI=2.61, 25.47) were independent predictors of death. Cerebral malaria, male gender, wasting, hypokalaemia, hyponatriaemia, azotaemia and renal impairment were significantly associated with death in univariate analysis but not logistic regression model.
  
  
  CONCLUSIONS
  Hypoxaemia predicts deaths in Nigerian children with severe malaria, irrespective of other features. Efforts should always be made to measure oxygen saturation as part of the treatments for severe malaria in children.
authors.affiliation: Institute of Child Health College of Medicine, University of Ibadan, Nigeria.
authors.forename: Adebola
authors.initials: A
authors.lastname: Orimadegun
authors.affiliation: Department of Paediatrics, College of Medicine, University of Ibadan, Nigeria.
authors.forename: Babatunde
authors.initials: B
authors.lastname: Ogunbosi
authors.affiliation: Department of Chemical Pathology, College of Medicine, University of Ibadan, Nigeria.
authors.forename: Bose
authors.initials: B
authors.lastname: Orimadegun
mesh_terms: D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D000860:Hypoxia / Q000175:diagnosis* / Q000209:etiology* / Q000401:mortality; D007223:Infant; D007231:Infant, Newborn; D016778:Malaria, Falciparum / Q000150:complications / Q000175:diagnosis* / Q000401:mortality* / Q000469:parasitology; D008297:Male; D018512:Parasitemia / Q000097:blood* / Q000150:complications / Q000401:mortality; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
keywords: Hypoxaemia; Oxygen saturation; Severe malaria; Under-5 mortality