Overview :

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:

• Kenyan children seen at a rural hospital

• children excluded if died upon arrival at the hospital or if died from causes other than severe malaria

• 84% of deaths occurred within 24 hours of admission

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.

Marsh K, Forster D, et al. Indicators of life-threatening malaria in African children. N Engl J Med. 1995; 332: 1399-1404.