Ippolito et al identified risk factors for mortality associated with severe malaria in children in Northern Zambia. These factors can help to identify a patient who may benefit from more aggressive management. The authors are from the Johns Hopkins University, Saint Paul's General Hospital (Nchelenge), Tropical Research Centre (Ndola) and Macha Research Trust in Zambia.

Patient selection: pediatric patient with severe malaria in Northern Zambia (age from 2 months to 18 years with median age 1 year and 11 months)


Severe malaria was defined as one or more of the following:

(1) severe anemia (hemoglobin < 5 g/dL)

(2) cerebral edema

(3) lactic acidosis

(4) respiratory failure

(5) shock


Risk factors for mortality:

(1) distance of home from hospital (odds ratio 1.04 per kilometer)

(2) delay in presentation

(3) severe anemia

(4) failure to transfuse if severely anemic (due to unavailability)


Recommendations to reduce mortality:

(1) improved transportation to the hospital

(2) initiation of therapy prior to transport

(3) rapid initiation of therapy (rapid triage, etc)

(4) readily available compatible blood products

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