Pattern and Outcome of Severe Malaria Among Children in Sokoto North Western Nigeria

Malaria still remains the leading cause of morbidity and mortality in Nigerian children. Despite the fact that it is a preventable and curable illness, its high incidence and prevalence continue unabated especially in the tropical sub-Saharan Africa. The objectives of this study was to determine the pattern of severe malaria with reference to the clinical and laboratory criteria and its outcome in children aged 1month - 15years. It was a prospective study conducted in children aged 1month 15 years with diagnosis of severe malaria admitted consecutively into the Emergency Paediatrics Unit (EPU), Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, Nigeria. Information of the patients with regards to their age, gender, date of admission, presenting clinical features, results of laboratory investigations, and outcome were entered into a study proforma sheet and analysed. Atotal of 1,715 children aged 1month - 15years were admitted into EPU, UDUTH, Sokoto. Of this number, 508 (29.6%) had clinical and parasitological case defining features of severe malaria. Males were 308 (60.6%) while the females were 200(39.4%) with M: F ratio of 1.5:1. The mean age of the children was 3.5 years (±3.44) with those aged 5years and below accounting for 78% of the patients. The most frequent criteria of severe malaria were prostration (38%), persistent vomiting (35%), hyperpyrexia (31%) and multiple convulsions (25%). There were 33 deaths which gave a case-fatality rate of 6.5 %. Fatal outcome was significantly affected by the occurrence of unconsciousness (cerebral malaria) (p=0.001), prostration (p=0.04), severe anaemia (p=0.04) and respiratory distress (p=0.01). Prostration, persistent vomiting, hyperpyrexia and multiple convulsions were the most common features of severe malaria in this study. However, fatal outcome was significantly associated with occurrence of unconsciousness (cerebral malaria), prostration, respiratory distress and severe anaemia. Hence, children with either of these features should be managed with utmost care and urgency.