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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

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severe malaria in children clinical features and prognostic indicators

SEVERE MALARIA IN CHILDREN: CLINICAL FEATURES AND PROGNOSTIC INDICATORS

A.Das, Chiranjib Ghosh, Supriya Choudhary*

Department of Pediatrics

Gauhati Medical College

introduction

INTRODUCTION

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.

aims and objectives

AIMS AND OBJECTIVES

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.

materials and methods

MATERIALS AND METHODS

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.

materials and methods contd

MATERIALS AND METHODS(contd)

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.

slide6

INVESTIGATIONS:

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.

materials and methods contd1

MATERIALS AND METHODS (contd)

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.

results and observations

RESULTS AND OBSERVATIONS

Age Distribution of malaria cases

results and observations contd

RESULTS AND OBSERVATIONS(contd)

OUTCOME OF MALARIA CASES

results and observations contd1

RESULTS AND OBSERVATIONS(contd)

Comparison of clinical features of severe malaria in

two age groups

results and observations contd2

RESULTS AND OBSERVATIONS(contd)

Comparison of complications of severe malaria in two age groups

results and observations contd3

RESULTS AND OBSERVATIONS(contd)

MORTALITY IN DIFFERENT COMPLICATIONS OF SEVERE MALARIA

results and observations contd4

RESULTS AND OBSERVATIONS(contd)

Asociation of PEM with outcome

p-value 0.001 (significant)

results and observations contd5

RESULTS AND OBSERVATIONS(contd)

Different laboratory parameters among outcome groups

conclusion

CONCLUSION

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.

slide21
Respiratory distress occurred even in absence of pneumonia, cardiac failure and severe anemia.

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.