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SEVERE MALARIA IN CHILDREN: CLINICAL FEATURES AND PROGNOSTIC INDICATORS. A.Das, Chiranjib Ghosh, Supriya Choudhary* Department of Pediatrics Gauhati Medical College. INTRODUCTION. Malaria is a serious problem in north eastern states of India. N E states contribute 8.5 -11% of total cases
A.Das, Chiranjib Ghosh, Supriya Choudhary*
Department of Pediatrics
Gauhati Medical College
Malaria is a serious problem in north eastern states of India.
N E states contribute 8.5 -11% of total cases
13 -15 % of national malarial mortality.
Assam reports the maximum.
Manifestations of severe malaria vary in different regions. Depends on endemicity.
A recent change noted in the spectrum of manifestations of severe malaria in south east region.
The present study was undertaken to observe
Manifestations of severe malaria in children and features associated with adverse outcome.
Difference in clinical manifestations in younger (upto 5 years)and older (above 5 years) children.
Effect of malnutrition on ultimate prognosis.
Incidence of hepatopathy & ARF in children and its outcome.
Place of study: Department of Pediatrics, Gauhati medical college and hospital.
Study period: October 2005 to September 2006.
Inclusion criteria: Slide positive confirmed cases of severe malaria according to WHO 2000 definition.
Data collection: was done in a standard proforma.
Clinical assesment was done according to WHO 2000 criteria for severe and complicated malaria.
Glassgow coma scale and Blantyre coma scale was used for assesment of state of consciousness.
DIAGNOSIS: done by study of thick and thin peripheral blood smear.
Peripheral blood smear,hemoglobin,blood sugar level done in all cases.
Blood urea,serum creatinine,TLC and estimation of parasite load ,Serum bilirubin (total &fraction),SGPT,prothrombin time,serum lactate done whenever possible.
Markers of viral hepatitis, CSF analysis, urine analysis and chest X- ray done whenever necessary.
Statistical analysis done using SPSS 11.1 programme
Sample T- test used to calculate significance of difference of means.
Z- test used to calculate significance of difference of proportions.
Chi-Square test used to calculate association of variables.
Multivariate analysis done to determine individual influence of various factors on outcome.
Age Distribution of malaria cases
OUTCOME OF MALARIA CASES
Comparison of clinical features of severe malaria in
two age groups
(contd on next page)
Comparison of complications of severe malaria in two age groups
MORTALITY IN DIFFERENT COMPLICATIONS OF SEVERE MALARIA
Asociation of PEM with outcome
p-value 0.001 (significant)
Different laboratory parameters among outcome groups
in malarial hepatopathy
Severe malaria common > 5 years
Cerebral malaria and severe anaemia - most common presentations
Cerebral malaria more common > 5 years
Acute renal failure and hepatopathy – fairly common complications.
Cerebral malaria –the most common underlying cause of death.
Metabolic acidosis as a cause needs further evaluation
Malnutrition- a significant contributor to poor outcome.
Hyperparasitaemia did not influence the outcome of severe malaria in children.