Study offeatures associated with death in children with severe malaria at a tertiary care hospital in Western India

Abstract

Background: India contributes significantly to world malaria load and it accounts for 6% of the total malaria cases, 49 % of the vivax malaria cases and 51% of vivax malaria deaths across the world. There is scarce informationabout predictors of mortality in children with severe malaria from India.

Objectives: To study the factors associated with death in children with severe malaria at a tertiary care hospital in western India.

Methods: A retrospective study was conducted at the pediatric department of a tertiary care hospital (Mumbai) over a three-year period. Demographic data, clinical and laboratory findings of patients with slide-positive malaria were collected from hospital records. Children with any one of the manifestations of severe malariaas per WHO protocol were enrolled in the study. Univariate and multiple regression analysis were usedto identify major predictors of death like: 1) Severe Anemia, 2) Respiratory distress, 3) Multiple generalized convulsions, 4) Spontaneous bleeding, 5) Hemoglobinuria, 6) Impaired consciousness, 7) Jaundice, 8) Prostration, 9) Circulatory Collapse, 10) Pulmonary oedema.

Results: Sixty-four subjectswere enrolled in the study. The case fatality rate was 20%. Thirty five (55%) patients presented with more than one predictor. The mortality rate was consistently high in patients having more than one predictor. Univariate analysis identified spontaneous bleeding (35% mortality)and multiple convulsions (60 % mortality) as major predictors of death. Multivariate analysis showed no single factor emerged as a significant predictor of death.

Conclusions: Spontaneous bleeding and multiple convulsions emerged as significant predictors of death during Univariate analysis. However no single factor emerged as significant predictor during multivariate analysis.