Clinical complications of malaria in Uganda children presenting to an emergency unit

ABSTRACT

To determine the major complications of malaria in children presenting to the Acute Care Unit; Mulago Hospital; Kampala; Uganda. METHODS: 148 charts of children admitted to the Acute Care Unit; with laboratory confirmed malaria were retrospectively reviewed; documenting clinical complications; haemoglobin estimation; level of parasitemia and treatment given. Thirty five children (24) had no documented complication and were excluded from the analysis. RESULTS: The median age for the 113 children analysed was 1.5 years (3 months - 12 yrs.) Eighty percent of the children were 3 years of age. The major clinical complications were severe anaemia in 58.4(66/113); febrile convulsions in 31.8(36/113); and cerebral malaria in 29.2(33/113) of the children. The median age for presentation were 11 months (3 months-6yrs) for severe anaemia; 1.3 years (4 months - 6 yrs) for febrile convulsions and 2 yrs (5 months - 12 years) for cerebral malaria. The children with severe anemia (Hb6g/dl) had a mean hemoglobin of 5.0g/dl (range 2.8-6.0g/dl). The level of parasitemia was highest in those children over 4 years; however; this was not statistically significant due to the small numbers. The treatment with chloroquine was documented in 57.5of the episodes; guinine in 43.1and both in 6.5. Chloroquine alone was used more frequently in those children less than 1 year and quinine in those over 2 years. This is related to the almost exclusive use of quinine in cerebral malaria patients. Conclusion: Malaria occurred most frequently in children under 3 years of age. The main complication in this group of Ugandan children was severe anemia. Age was the major predictor of each complication as well as treatment given. Malaria in children needs to be aggressively managed to avoid these complications