Conference abstract

Management and outcomes of severe malaria in a Pediatric intensive care unit, Koutiala, Mali

Pan African Medical Journal - Conference Proceedings. 2018:9(3).08 Dec 2018.
doi: 10.11604/pamj-cp.2018.9.3.729

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Keywords: Severe malaria, cerebral malaria, shock, mortality

Management and outcomes of severe malaria in a Pediatric intensive care unit, Koutiala, Mali

Matthew Coldiron1,&, Joseph Sagara2, Christopher Mambula3, Tomas Jensen4, Lisa Umphrey5, Myrto Schaefer5, Rebecca F. Grais1

1Epicentre, Paris, France, 2Médecins Sans Frontières, OCP, Koutiala, Mali, 3Médecins Sans Frontières, OCP, Paris, France, 4Médecins Sans Frontières, OCP, New York, US, 5Médecins Sans Frontières, OCP, Sydney, Australia

&Corresponding author
Matthew Coldiron, Epicentre, Paris, France


Introduction: there have been few breakthroughs in the treatment of severe malaria since the AQUAMAT trial, where case fatality was still 8.5% among children receiving artesunate. Questions remain regarding best strategies for fluid management and treatment of co-infection.

Methods: data were collected prospectively on all children admitted to ICU in Koutiala, Mali, for one year beginning in July 2015. Clinical and laboratory information was collected from charts during the first 24 hours of ICU care. Children were followed until hospital discharge. Data were anonymized and described. Risk ratios were calculated using log-binomial regression.

Results: severe malaria caused 2524 admissions (71% of all ICU admissions). 60% were admitted within 3 days of symptom onset. On admission, 552 (22%) had a serum glucose <60mg/dl and 208 (11%) <20mg/dl. Median serum hemoglobin was 6.0g/dl (IQR 4.3 - 8.3); 1216 (48%) children received at least one transfusion during the first 24 hours of hospitalization. In terms of other treatments, 2113 (84%) of children received at least one antibiotic, of whom 99% received ceftriaxone. Blood cultures were collected from only 227 patients during the first 24 hours; 26 grew any pathogenic bacteria, including 16 non-typhi salmonella. Nonetheless, case fatality remained high: 284/2524 (11%). Risk factors for mortality included seeking care ≥4 days after symptom onset (RR 1.9, 95% 1.6 - 2.2) and hypoglycemia (RR 3.4, 2.9 - 4.0). Sex and age were not significant risk factors. Receiving a transfusion was associated with a lower risk of inhospital mortality, even after controlling for hemoglobin at admission (RR 0.6, 95% CI 0.5 - 0.7). Children with a positive blood culture were not more likely to die.

Conclusion: despite reasonably good access to care and treatment following current standards, case fatality due to malaria remains high in this setting. Innovation in the treatment of severe malaria is urgently needed.