Clinical presentation and diagnosis of cerebral malaria in children in thehighlands of Western Kenya

Background: The clinical presentation of cerebral malaria in children in th e highlands has not been documented Objective: To describe the presentation of cerebral malaria in the age grou p one to twelve years. Design: Prospective study conducted from May to September 1997, the rainy s eason during which malaria occurs in epidemics in the highlands of Kenya, Setting: Paediatric wards of the Moi Teaching and Referral Hospital, Eldore t which is the Teaching Hospital for Moi University and the referral centre for surrounding districts of Western Kenya, with an altitude of over 2000 metres above sea level. Patients: Twenty three consecutive children aged one to twelve years with c erebral malaria as defined by the WHO were studied, All children were treat ed with the standard quinine regimen for cerebral malaria. Results: Majority of the children were six to ten years of age with 95.7% h aving a normal weight for age, 91.3%, 89.5% and 72.2% had fever, headache a nd convulsions respectively. 68.1% had a short duration of illness (less th an three days) with only 9.5% presenting with hypoglycaemia. Severe anaemia was not observed but 72% had mild to moderate anaemia. Hyperparasitaemia ( parasite counts greater than 100000 per microlitre) was found in majority o f the cases. Conclusion: Cerebral malaria presentation in the highlands is similar to th at among non-immune populations and is an acute fulminant illness presentin g with coma, hyperparasitaemia, fever and convulsions in children with norm al nutritional status.