SEVERE MALARIA IN CHILDREN IN PAPUA-NEW-GUINEA

The clinical features of severe falciparum malaria and risk factors fo r mortality were studied in 489 children admitted with malaria to Mada ng Hospital, Papua New Guinea. The most common severe manifestations o f malaria were severe anaemia (22%) and coma (16%). Children with seve re anaemia were younger than those with coma (median age 2.2 vs. 3.7 y ears) and had been ill for longer before admission (median 7 vs. 4 day s, respectively). Although the clinical features of coma in Madang chi ldren with malaria resembled closely those reported in African childre n, mortality was lower (8% vs. 17-25%, respectively). Overall, 17 (3.5 %) children died, most within 12 h of admission. A high level of plasm a lactate (greater than or equal to 5 mmol/l) was common (20%) and was the major predictor of death in multiple regression analysis. Raised plasma creatinine and decreased plasma bicarbonate were also independe nt predictors of mortality. Coma was not predictive of death, although a high proportion of children with profound coma died. Investigation of the causes of acidosis in children with malaria is a high research priority. In view of the short time interval between admission and dea th in many children, emphasis must be placed on the prevention or earl y recognition and treatment of acidosis in the district health clinic as well as the central hospital.