Pattern of severe and complicated malaria in children Admitted to Gondar Medical College hospital during 1995-2000

Abstract

Abstract Objective: To describe complications and predictors of mortality among severely complicated cases of malaria. Design: A retrospective Medical record analysis. Setting: Gondar Collage of Medical Sciences (GCMS) hospital, Gondar, Northwest Ethiopia. It is one of the teaching hospital in the country and the referral hospital in the Amahara regional state. Subjects: Clinical records of 427 patients admitted with a primary diagnosis of severe and "complicated malaria" that were admitted between September 1995 and August 2000 were analysed. Results: Of the 6100 patients admitted during the study period 427 (7%) had a primary diagnosis of malaria. Over half of them (55.1%) were male patients. Blood film was positive in 248/422(58.7%) of them and the rest were diagnosed on clinical ground as probable cases of sever malaria. Children below 6 years of age comprised 65.6% of the total cases. Severe anaemia, coma and hypoglycaemia were found as overlapping clinical features in 369 (86.4%) of them. The over all cases fatality rate was 15.2%. The case fatality rate of malaria associated with coma was 22.9%. When adjustments were made for severe anaemia and hypoglycaemia the fatality rated dropped to 17.9%. The worst predictors of mortality among the known compilations are; shock [OR=22.8 (95% CI=7.2-72.7)] ARDS [OR=5.7(95% CI=0.4-92.8)] pneumonia [OR=3.4(95% CI=1.5-7.4)] Severe anaemia [OR=2.15(95% CI=1.20-3.86)], coma [OR=2.08(95% CI=1.86- 3.66). The mean hospital stay of all patients was 7.9 days. Conclusion and recommendation: Once signs of complications are detected there is little time to save the child. Thus emphasis must be given to the management of cases in the nearest health institution. [Ethiop. J. Health Dev. 2002;16(1):53-59]