PREDICTORS OF SEVERITY OF ILLNESS ON PRESENTATION IN CHILDREN WITH CEREBRAL MALARIA

The presenting features of 195 children with cerebral malaria were ana lysed to determine which correlated with severity of coma and anaemia. The children, who came from a single community in southern Zambia, we re enrolled in an ongoing blinded drug trial in 1992 and 1993. Childre n with deep coma (scoring 0-2) had significantly longer duration of co ma before presentation (P=0.019) and were more likely to have been tre ated with chloroquine (P=0.022) than children with light coma (scoring 3 or 4 on the Blantyre coma scale). Children with severe anaemia (hae matocrit 18%) were younger (P=0.005), had been febrile longer (P=0.005 ), had splenomegaly (P<0.005) and hppoglycaemia (P<0.008)more often an d were more likely to have been treated with chloroquine (P<0.005) tha n those without severe anaemia. The counts of asexual parasites in the peripheral blood were not significantly correlated with depth of coma or severity of anaemia. The observed widespread and uncontrolled use of chloroquine has probably led to the development of resistant malari a and of many severe complications despite early consultation. While e arly treatment of febrile illnesses in young children and immediate me dical attention for altered consciousness must be emphasized in the co mmunity approach to severe malaria, our data indicate that effective p ublic health measures will be difficult to develop in the face of a hi gh prevalence of chloroquine resistance.