Clinical aspects and outcome of suspected severe pediatric malaria

Objective
The authors had for aim to evaluate diagnosis and treatment practices applied to children with clinically suspected severe malaria, in two referral hospitals of Kisangani.
Patients and methods
A prospective study was carried out between January 1, 2010 and February 28, 2011 including all children admitted for clinically suspected severe malaria, with at least one of the WHO severity criteria.
Results
One thousand one hundred and fifty-four children were admitted in the two hospitals, 427 (37.0%, n = 1.154) for clinically suspected severe malaria: 155 (36.3%, n = 427) had a positive thick drop examination (TDE), 198 (46.4%, n = 427) a negative one, and 74 (17.3%, n = 427) without thick blood smear examination. Prostration (48.0%) and anemia (40.3%) were the most common severity criteria, while 14.5% and 9.8% presented with convulsions and impaired consciousness respectively. The etiological treatment was quinine infusion. The case specific fatality rate was 19.4% (n = 427), 7.7% (n = 155) in confirmed cases, 9.6% (n = 198) in patients with negative thick blood smear, and 70.3% (n = 74) in patients without any TDE (P < 0.001).
Conclusion
Poor technical support and inadequate organization of the patient circuit can result in underestimating the metabolic complications of severe malaria and of other severe infections of early childhood. This is detrimental to the patients, even when effective drugs are available.