Cerebral malaria and the prognostic indicators in children of central Sudan

ABSTRACT

Identifying children with cerebral Malaria [CM] who are at high risk of a fatal outcome depends on recognition of clinical signs, as well as laboratory variables. No comprehensive data on the clinical features and their importance in the prognosis of cerebral malaria in the Sudan are available. The aims of this study were to identify the clinical presentation of children with CM in Central Sudan and to evaluate the importance of clinical signs and laboratory investigations in determining the outcome of CM in children. 409 children [mean age 6.1 +/- 3.3 years] with CM were enrolled to the study. Comprehensive clinical and biochemical assessment were determined. The case fatality rate was 12% with the highest rate in younger children [< 2 years of age]. Univariate and multiple regression analysis identified six significant prognostic indicators in these children. These are, age posture [RR, 2.988; 95% CI, 1.943 - 4.595], deep coma [RR, 3.744; 95% CI, 1.308 - 10.715], respiratory distress [RR, 1.114; 95% CI, 1.004 - 1.235], blood urea >/= 6.6 mmol/L [RR, 3.989; 95% CI, 2.359 - 6.746] and haemoglobin concentration laboratory findings are good prognostic indicators in Sudanese children with CM. Age, abnormal posture, Blantyre coma score, respiratory distress, blood urea and haemoglobin concentration can identify those at high risk of death in children with CM