INDICATORS OF FATAL OUTCOME IN PEDIATRIC CEREBRAL MALARIA - A STUDY OF 134 COMATOSE PAPUA-NEW-GUINEAN CHILDREN

Background. No comprehensive data on the clinical features and the pro gnosis of cerebral malaria in the South Pacific are available at prese nt. We conducted a prospective study in children with cerebral malaria to assess the case fatality rate (CFR) in the region and to identify potential risk factors for death. Methods. We recruited 134 children a dmitted to the Madang General Hospital between April 1991 and October 1993 with a strictly defined diagnosis of cerebral malaria. Besides cl inical examination, we collected a blood sample for parasitological, h aematological and biochemical assessment. Results. The CFR was 11.9% a nd the prevalence of residual neurological sequelae at discharge was 1 .5%. The proportion of children presenting with deep coma (12%) or hyp oglycaemia (17%) was lower in our study than in African ones, where se vere complications are more frequent. Also mortality associated with h ypoglycaemia on admission was lower. Clinical or laboratory conditions significantly associated with death were deep coma, malarial anaemia and hyperleucocytosis. Conclusions. All conditions associated with dee p coma, such as shock, hypoglycaemia and acidosis, should be corrected . Also prompt administration of blood transfusions to patients with an aemia is likely to reduce the occurrence of death in Papua New Guinean children with cerebral malaria.