Outcome of severe malaria in children in two district hospitals in Cameroon

Abstract

Malaria is a major endemic parasitic disease and remains the main cause of morbidity and mortality in sub-Saharan Africa. Children less than 5 years old carry the largest part of this burden with 3000 deaths daily. Case management of severe malaria is a main problem in Cameroon. The regime proposed by the WHO needed to be tested in African countries to prove its effectiveness and efficacy before adoption. This is thus part of a multi-centre study. Our main aim was to describe the evolution and outcome of severe malaria on management following the current WHO treatment guidelines. From January 1st to August 31st 2000, 148 children aged from 6 to 59 months with at least one feature of severe malaria were recruited by consecutive sampling at Djoungolo and Mfou district hospitals. Treatment according to WHO guidelines was implemented and there was rigorous in-patient monitoring and outpatient follow-up. The incidence of severe malaria was 21.1%. The male/female ratio was 1.06. The commonest clinical forms of severe malaria were: generalised convulsions (54.7%), prostration (43.2%) and severe anaemia (14.9%). The case management of severe malaria was effective, for, the mean fever clearance time was 27.9 ± 21.4 hours, the mean coma recovery time was 36.0 ± 17.0 hours, the parasitaemia reduced by 96.5% 48 hours after onset of treatment and haematocrit increased from 26.4% ± 6.7 initially to 33.7% ± 3.7 on day 28. Most children (95.9%) were completely cured, 2.0% died and there was no neurological deficit over 1 month follow-up. We recommend the generalisation of the protocol throughout the national territory in Cameroon and further training of health personnel to facilitate the utilisation of the protocol.

Keywords: severe malaria, children, case management, WHO guidelines, evolution, outcome

Clinics in Mother and Child Health Vol. 2(1) 2005: 247-252