Severe falciparum malaria is an important cause of death in African children. Children at risk for death can be identified by certain clinical indicators.
Patient Population:
(1) Kenyan children seen at a rural hospital
(2) children excluded if died upon arrival at the hospital or if died from causes other than severe malaria
(3) 84% of deaths occurred within 24 hours of admission
|
Indicator from Logistic Regression Analysis
|
Relative Risk
|
95% Confidence Interval
|
|
impaired consciousness
|
3.3
|
1.6-7.0
|
|
respiratory distress
|
3.9
|
2.0-7.7
|
|
hypoglycemia
|
3.3
|
1.6-6.7
|
|
jaundice
|
2.6
|
1.1-6.3
|
where:
• impaired consciousness is when a patient has a depressed level of consciousness but can localize a painful stimulus (appears to correspond to a Blantyre coma score <= 2)
• if a child had a seizure, determination of consciousness level was delayed for 1 hour after spontaneous termination of seizure or for 6 hours if seizures controlled with anticonvulsant drugs, to prevent influence of any transient post-ictal phenomenon
• prostration is determined by observing whether a sitting position could be maintained without support from an attendant
• respiratory distress is indicated by the presence of any of the following signs: alar flaring, chest recession (intercostal or subcostal), use of accessory muscles of respiration, or abnormally deep breathing
• hypoglycemia is a blood glucose < 40 mg/dL (2.2 mmol/L)
84.4% of fatal cases could be identified by presence of impaired consciousness and/or respiratory distress, versus 79.7% by WHO criteria.
