Cerebral Malaria: Presentation and Outcome in Children in Sokoto

Abstract

Malaria remains a major cause of high mortality in African Children. A high percentage of these deaths are caused by cerebral malaria (CM). Therefore, this study sought to determine prospectively, the clinical pattern and outcome of CM in children aged 6months to l2years admitted consecutively into the Emergency Paediatrics Unit (EPU), Usmanu Danfodiyo University Teaching Hospital Sokoto, over a one-year period. (1” June 1999 and 31st May 2000). The level of consciousness was assessed using the Blantyre coma scale for children. Intravenous Quinine dihydrochloride was the antimalarial drug of choice. A total of 971 children were admitted into EPU over the study period. Seventy eight (8.0%) of them had CM. fifty (64%) of the patients were aged 1-5 years. The principal presenting clinical features were fever in seventy eight (100%), loss of consciousness, 78 (100%), and convulsions, 66 (85%). Signs of decerebration, retinal haemorrhages and papilloedema occurred in 23 (30%), 7 (9%), and 5 (6.4%) patients, respectively. Fifty-eight (74%) patients survived, while 20 (26%) died. In conclusion, the hospital prevalence of CM in this series was 8% and ages I to 5 years were the ages of greatest susceptibility. Age less than 3 years, Blantyre coma score of 0, signs of decerebrate rigidity, acidotic (Kussmaul's) respiration, retinal haemorrhages, papilloedema, hypoglycaemia, and raised plasma urea concentrations were indicators, on admission, of poor outcome/prognosis. The case fatality rate of 26%, though within the range reported in literature, remains significantly high. Therefore, skilled, meticulous, and appropriate medical and good nursing care of these patients is strongly advocated.

Nigerian Medical Practitioner Vol. 50 (3&4) 2006: pp. 55-61