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Q J Med 2003; 96: 427-434
© 2003 Association of Physicians

Severe P. falciparum malaria in Kenyan children: evidence for hypovolaemia

K. Maitland1, M. Levin1, M. English2, S. Mithwani, N. Peshu, K. Marsh3 and C.R.J.C. Newton4

From the Centre for Geographic Medicine Research, Coast, KEMRI/Wellcome Trust Unit, P.O. Box 230, Kilifi, Kenya, 1Department of Academic Paediatrics, Imperial College, London, 2Department of Paediatrics, University of Oxford, Oxford, 3Nuffield Department of Medicine, University of Oxford, Oxford, and 4Neurosciences Unit, Institute of Child Health, University College London, London, UK

Received 1 October 2002 and in revised form 17 February 2003

Background: The role of volume resuscitation in severe Plasmodium falciparum malaria is controversial.

Aim: To examine the role of hypovolaemia in severe childhood malaria.

Study design: Retrospective review.

Methods: We studied 515 children admitted with severe malaria to a high-dependency unit (HDU) in Kilifi, Kenya. On admission to the HDU, children underwent a further assessment of vital signs and a standard clinical examination.

Results: Factors associated with a fatal outcome included deep breathing or acidosis (base excess below –8), hypotension (systolic blood pressure <80 mmHg), raised plasma creatinine (>80 µmol/l), low oxygen saturation (<90%), dehydration and hypoglycaemia (<2.5 mmol/l). Shock was present in 212/372 (57%) children, of whom 37 (17.5%) died, and was absent in 160, of who only 7 (4.4%) died ({chi}2 = 14.9; p = 0.001).

Discussion: Impaired tissue perfusion may play a role in the mortality of severe malaria. Moreover, volume resuscitation, an important life-saving intervention in children with hypovolaemia, should be considered in severe malaria with evidence of impaired tissue perfusion.

Address correspondence to Dr Kathryn Maitland, KEMRI/Wellcome Trust Unit, P.O. Box 230, Kilifi, Kenya. e-mail: kmaitland{at}kilifi.mimcom.net


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