Predictors of mortality in Gambian children with severe malaria anaemia

Severe malaria anaemia is a frequent cause of admission to hospital in tropical Africa and about 10% of children with this condition die. To determine ways in which mortality might be reduced we have studied risk factors for a fatal outcome in 173 children with severe malaria anaemia who were assigned to receive blood transfusion because they had a packed cell volume of less than 12% and/or signs of respiratory distress. Twenty-three children died (13%); in 15 cases (65%) death occurred before blood transfusion was given. The presence of respiratory distress was found to be the most important predictor of death. Children with severe malaria anaemia and signs of respiratory distress must therefore be transfused as soon as possible. Severe anemia is a major cause of morbidity and mortality among children in Africa. In areas of moderate seasonal transmission, cerebral malaria is the dominant form of severe malaria. Severe malaria anemia is a frequent cause of admission to hospital in tropical Africa, and results in the death of about 10% of children with the condition. While children with severe malaria anemia can often be saved from death by blood transfusion, deaths from the condition continue to occur even in centers in which transfusion is available. Findings are presented from a study conducted at Royal Victoria Hospital, Banjul, the main referral hospital in The Gambia, to determine how such mortality may be reduced. The authors studied risk factors for a fatal outcome in 173 children of mean age 25.3 months with severe malaria anemia who were assigned to undergo blood transfusion because they had a packed cell volume of less than 12% and/or signs of respiratory distress. 15 of the 23 children who died did so before receiving transfused blood. The presence of respiratory distress was found to be the most important predictor of death. These findings suggest that children with severe malaria anemia and signs of respiratory distress should be transfused as soon as possible