Clinical presentation and Predictors of mortality in severe malaria in pediatric population: A prospective observational study

Background: Malaria remains a significant public health in India and a major cause of under 5 mortality. Clinical manifestations of malaria in children may differ significantly from adults and there is wide variation in manifestation depending on endemicity. We conducted this study to find the clinical presentation and features which would predict mortality in children with severe malaria. Methods: a prospective observational study was conducted at Pediatric units of SCB Medical College, Cuttack. Children below 14 years of age with confirmed diagnosis of malaria and satisfying the WHO criteria for severe malaria were included in the study. Baseline demographic data collected and clinical features during the course of illness were documented. Logistic regression analysis was used to find the predicting factors for mortality. Result: out of 557 cases with malaria over a period of 20 months, 130 patients (23.3%) satisfied the WHO criteria for severe malaria. Case fatality rate was 8.5%. Apart from fever, anemia and prostration were most commonly associated complications. Presence of respiratory distress, CNS involvement, shock and renal failure were found to be the major predictor of death. Risk of mortality increased significantly with the presence of multiple organ dysfunction. About 12.3% of the patients were G6PD deficient. A higher incidence of hemoglobinuria and a lower incidence of cerebral malaria was observed in G6PD deficient patients. Conclusion: Complications associated with severe malaria in pediatric populations in India differ from African countries. Multiple organ dysfunction is not uncommon in the pediatric population and it significantly increases the chances of adverse outcome.