Ann Infect Dis Epidemiol | Volume 2, Issue 3 | Research Article | Open Access
Patrick Gérardin*, Amadou Sidy Ka and Patrick Imbert
Department of Pediatrics, Groupe Hospitalier Sud-Réunion, France
*Correspondance to: Patrick Gérardin
Fulltext PDFBackground: Whether there are alternative indicators than WHO criteria to assess malaria severity and outcome is not addressed in non-immune children.
Methods: To assess outcome of severe malaria among non-immune children, we conducted a prospective hospital-based study in Dakar (Senegal), a low transmission setting which delays development of clinical immunity.
Results: Of 311 falciparum cases (median age: 8 years), 233 (75%) matched 2000 WHO definition of severe malaria. The fatality rate was 9% (n=28). Logistic-regression analysis identified seven key prognostic factors : thrombocytopenia (platelets <100,000/mm3) (44.3%; odds ratio (OR), 6.1; 95% confidence interval (CI), 1.7 to 20.9), respiratory distress (30.5%; OR 3.2; 95% CI, 1.02 to 9.9), unrousable coma (inability to localize a painful stimulus with Blantyre coma score (BCS) ≤ 3) (26.3%; OR 8.1; 95% CI, 2.1 to 33.4), sluggish pupils (12.2%; OR 4.1; 95% CI, 1.1 to 14.7), hypoglycemia (11.2%; OR 5.8; 95% CI, 1.6 to 21.1), acute renal failure (2.2%; OR 17.9; 95% CI, 2.4 to 133), and the combination of jaundice, macroscopic hemoglobinuria and abnormal bleeding (21.2%; OR 3.1; 95% CI, 1.04 to 9.2). Gathering together children with impaired consciousness (BCS <5), thrombocytopenia or respiratory distress, the three most frequent conditions associated with malaria, we found the same discriminatory performance in predicting outcome than the 2000 WHO criteria (overlap, 87%, sensitivity, 100%, specificity, 28%, positive predictive value, 80%, negative predictive value, 100%). Conclusions: WHO criteria (2000) provide a highly sensitive definition of severe malaria than can be replaced by three simple indicators in non-immune Senegalese children.
Malaria; Children; Thrombocytopenia
Gérardin P, Sidy Ka A, Imbert P. Can the Assessment of Malaria Severity be Simplified for Non-immune African Children? Ann Infect Dis Epidemiol. 2017;2(3):1021.