CLINICAL-FEATURES AND OUTCOME OF SEVERE MALARIA IN GAMBIAN CHILDREN

The clinical and laboratory features of severe falciparum malaria in 1 80 Gambian children were studied between 1985 and 1989. Of the 180 chi ldren, 118 (66%) presented with seizures, 77 (43%) had cerebral malari a, 35 (20%) had witnessed seizures after admission, 29 (16%) were hypo glycemic, and 27 (15%) died. Respiratory distress was a common harbing er of a fatal outcome. The differences in admission parasite counts in the blood, hematocrit, and opening cerebrospinal pressures for patien ts who died and survivors were not significant. A multiple logistic re gression model identified neurological status (coma, particularly if a ssociated with extensor posturing), stage of parasite development on t he peripheral blood film, pulse rate of >150 or respiratory rate of >5 0, hypoglycemia, and hyperlactatemia (plasma lactate level, >5 mmol/L) as independent indicators of a fatal outcome, Biochemical evidence of hepatic and renal dysfunction was an additional marker of a poor prog nosis, but, in contrast to severe malaria in adults, none of these chi ldren with severe malaria had acute renal failure.