Journal of Tropical Pediatrics Advance Access published online on January 22, 2008
Journal of Tropical Pediatrics, doi:10.1093/tropej/fmm108
In-Hospital Risk Estimation in Children with Malaria—Early Predictors of Morbidity and Mortality
aDepartment of Neurology, University of Ulm, Ulm, Germany
bHaydom Lutheran Hospital, Manyara Region, Tanzania
cDepartment of Neurology, Medical University of Innsbruck, Innsbruck, Austria
dDepartments of Paediatrics and Neurology, Muhimbili Medical Centre, Dar es Salaam, Tanzania
Correspondence: Dr AS Winkler, Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081 Ulm, Germany. Tel: +49/89/142097, Fax: +49/89/14337947, E-mail: < drawinkler{at}yahoo.com.au>.
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Abstract |
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Background: Rapid diagnosis and adequate therapy are crucial to prevent development of severe disease and death in children suffering from malaria. A reliable but easy system for disease severity assessment would help to fast track seriously ill children and provide suitable therapies for different patient groups.
Objectives: To examine risk factors and appropriate scoring systems in children suffering from malaria for outcome in terms of morbidity and mortality.
Methods: A prospective, consecutive study in children admitted to the Muhimbili Medical Centre in Dar es Salaam was conducted to evaluate risk factors and test appropriate scoring systems. The simplified Multi-Organ Dysfunction Score (sMODS), a severity of disease classification consisting mainly of clinical data, was applied. Chosen outcome parameters were morbidity and mortality. Results were compared to those obtained from the World Health Organisation (WHO) classification of severe malaria, the Blantyre Coma Scale (BCS) and selected single clinical parameters.
Results: Seventy-five children were recruited into the study. Mean age was 28 months ranging from 6 months to 8 years. ‘Severe Malaria’, according to WHO criteria was evident in 57 patients (76%). Mean sMODS on admission was 15.6 ± 2. Seven patients (9%) died. Among single symptoms, impaired consciousness and respiratory distress predicted both, fatal outcome and morbidity. In terms of scoring systems, the sMODS correlated with both outcome parameters. In comparison, the WHO criteria did not correlate with any of the two parameters, the BCS correlated with mortality only.
Conclusion: In our study, sMODS has been shown to represent a useful quantitative approach towards disease severity classification in resource poor settings and can be used for risk estimation in children suffering from malaria in terms of both morbidity and mortality.