MANAGEMENT OF SEVERE MALARIAL ANEMIA IN GAMBIAN CHILDREN

The optimum management of children with severe malarial anaemia is sti ll uncertain. Hence, we have undertaken a study to determine whether i ron treatment is as effective at restoring haemoglobin levels one mont h after presentation as blood transfusion without iron treatment in ch ildren with moderately severe malarial anaemia. Two hundred and eighty -seven children with a packed cell volume (PCV) <15% and malaria infec tion were recruited into the study; 173 children were assigned to rece ive blood transfusion because they had a PCV <12% and/or signs of resp iratory distress and the remaining 114 children were allocated at rand om to receive either blood transfusion (58) or treatment with oral iro n (56) for 28 d. Twenty-four children died, 23 in the most severely an aemic group. Fifteen children (65%) died before transfusion was given and most deaths occurred within the first 4 h of admission. One child died in the iron treatment group and 10 subsequently required transfus ion. Among the severely anaemic children, those with respiratory distr ess were at greater risk of death than those without respiratory distr ess. After 28 d, haematological restoration was significantly better i n children who had received iron than in those treated by blood transf usion (P=0.02). Children who received malaria chemoprophylaxis after d ischarge from hospital had fewer episodes of malaria and subsequent ad missions to a hospital or health centre than those who did not. Childr en with severe anaemia and clinical signs of respiratory distress must be identified quickly and transfused as soon as possible. However, fo r less severely anaemic children who are clinically stable, iron thera py offers an alternative to transfusion provided such children can be kept under surveillance and transfused subsequently should this become necessary.