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SEVERE MALARIA IN CHILDREN: CLINICAL FEATURES AND PROGNOSTIC INDICATORS

SEVERE MALARIA IN CHILDREN: CLINICAL FEATURES AND PROGNOSTIC INDICATORS. A.Das, Chiranjib Ghosh, Supriya Choudhary* Department of Pediatrics Gauhati Medical College. INTRODUCTION. Malaria is a serious problem in north eastern states of India. N E states contribute 8.5 -11% of total cases

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SEVERE MALARIA IN CHILDREN: CLINICAL FEATURES AND PROGNOSTIC INDICATORS

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  1. SEVERE MALARIA IN CHILDREN: CLINICAL FEATURES AND PROGNOSTIC INDICATORS A.Das, Chiranjib Ghosh, Supriya Choudhary* Department of Pediatrics Gauhati Medical College

  2. INTRODUCTION Malaria is a serious problem in north eastern states of India. N E states contribute 8.5 -11% of total cases 13 -15 % of national malarial mortality. Assam reports the maximum. Manifestations of severe malaria vary in different regions. Depends on endemicity. A recent change noted in the spectrum of manifestations of severe malaria in south east region.

  3. AIMS AND OBJECTIVES The present study was undertaken to observe Manifestations of severe malaria in children and features associated with adverse outcome. Difference in clinical manifestations in younger (upto 5 years)and older (above 5 years) children. Effect of malnutrition on ultimate prognosis. Incidence of hepatopathy & ARF in children and its outcome.

  4. MATERIALS AND METHODS Place of study: Department of Pediatrics, Gauhati medical college and hospital. Study period: October 2005 to September 2006. Inclusion criteria: Slide positive confirmed cases of severe malaria according to WHO 2000 definition. Data collection: was done in a standard proforma.

  5. MATERIALS AND METHODS(contd) Clinical assesment was done according to WHO 2000 criteria for severe and complicated malaria. Glassgow coma scale and Blantyre coma scale was used for assesment of state of consciousness. DIAGNOSIS: done by study of thick and thin peripheral blood smear.

  6. INVESTIGATIONS: Peripheral blood smear,hemoglobin,blood sugar level done in all cases. Blood urea,serum creatinine,TLC and estimation of parasite load ,Serum bilirubin (total &fraction),SGPT,prothrombin time,serum lactate done whenever possible. Markers of viral hepatitis, CSF analysis, urine analysis and chest X- ray done whenever necessary.

  7. MATERIALS AND METHODS (contd) Statistical analysis done using SPSS 11.1 programme Sample T- test used to calculate significance of difference of means. Z- test used to calculate significance of difference of proportions. Chi-Square test used to calculate association of variables. Multivariate analysis done to determine individual influence of various factors on outcome.

  8. RESULTS AND OBSERVATIONS Age Distribution of malaria cases

  9. RESULTS AND OBSERVATIONS(contd) OUTCOME OF MALARIA CASES

  10. RESULTS AND OBSERVATIONS(contd) Comparison of clinical features of severe malaria in two age groups

  11. Comparison of clinical features of severe malaria in two age groups(contd)

  12. Association of clinical features with outcome (contd on next page)

  13. Association of clinical features with outcome (contd)

  14. RESULTS AND OBSERVATIONS(contd) Comparison of complications of severe malaria in two age groups

  15. RESULTS AND OBSERVATIONS(contd) MORTALITY IN DIFFERENT COMPLICATIONS OF SEVERE MALARIA

  16. RESULTS AND OBSERVATIONS(contd) Asociation of PEM with outcome p-value 0.001 (significant)

  17. RESULTS AND OBSERVATIONS(contd) Different laboratory parameters among outcome groups

  18. Different laboratory parameters among outcome groups

  19. Relation between SGPT and bilirubin levels in malarial hepatopathy

  20. CONCLUSION Severe malaria common > 5 years Cerebral malaria and severe anaemia - most common presentations Cerebral malaria more common > 5 years Acute renal failure and hepatopathy – fairly common complications. Cerebral malaria –the most common underlying cause of death.

  21. Respiratory distress occurred even in absence of pneumonia, cardiac failure and severe anemia. Metabolic acidosis as a cause needs further evaluation Malnutrition- a significant contributor to poor outcome. Hyperparasitaemia did not influence the outcome of severe malaria in children.

  22. ....THANK YOU

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