Severe malaria in children:Factors predictive of outcome and response to Quinine

Objective: To identify clinical features of severe malaria and their association with adverse outcomes according to recently proposed WHO guidelines and observe treatment failure to Quinine. Methods: This descriptive study was performed at Civil Hospital Karachi from September 2007 to January 2008.Various clinical features and laboratory parameters were analyzed according to t WHO guidelines and treatment failure to anti-malarial drugs was recorded. Mean, frequencies, percentages and chi-square test were used for analysis. Statistical significance was defined as p-value <0.05. Results: Total of 81 patients were enrolled in the study. Mean age of children was 5.5 ± 3.4 years. Type of malaria infections that were seen included falciparum 46(57%), mixed infection 26(32%) and vivax 9(11%). Frequent clinical features included splenomegaly (74%), multiple organ dysfunction (MOD) (70%), cerebral malaria (31%) and malnutrition (27%). Thrombocytopenia (86%) and severe anaemia (42%) were the common laboratory findings. Shock (p<0.001), renal failure (p<0.001), hepatic involvement (p<0.002) and cerebral malaria (p<0.002) emerged as strong predictors of complications. Fourteen out of 81 cases showed early treatment failure to Quinine. Conclusion: Shock, renal failure, hepatic involvement and cerebral malaria are strongly associated with complications in severe malaria. MOD and malnutrition were identified as significant new clinical features present in severe malaria in this study.