THE ASSOCIATION OF PALLOR WITH HEMOGLOBIN CONCENTRATION AND MORTALITYIN SEVERE MALARIA

To identify a marker associated with poor outcome in severe malaria th at requires no technology, the relationship between the presence of pa llor and mortality was reviewed retrospectively in 291 Zambian childre n with cerebral malaria. The mean (S.D.) haemoglobin concentration amo ng the 222 children assessed as having pallor on admission was signifi cantly lower than that among the 69 children not considered to have pa llor [6.0 (1.9) v. 9.2 (1.6) g/dI; P<0.0005]. Thirty-nine (17.6%) of t he children presenting with pallor died, compared with only five (7.2% ) of those without pallor (P=0.036). The adjusted odds of death in chi ldren with pallor on admission was 2.8 times higher than that in child ren without pallor (95% confidence interval = 1.03-7.7; P=0.044). The clinical observation of pallor may therefore identify children with lo w haemoglobin concentrations and a high risk of mortality. Whether mot hers and village health workers can be taught to recognize pallor in a child with malaria and then to seek early medical attention will need to be determined in further studies.