Clinical Presentation and Outcome in Children Admitted with Severe Malaria

Niaz Hussain; Saima Rayaz; Naziah; Arbab Nadeem Akhtar; Muhammad Hanif; Ghazala Habib

doi:10.70749/ijbr.v3i3.845

Authors

Niaz Hussain Department of Paediatrics, Bolan Medical Complex Hospital, Quetta, Balochistan, Pakistan.
Saima Rayaz Department of Paediatrics, Sandeman Provincial Hospital/ Bolan Medical Complex Hospital, Quetta, Balochistan, Pakistan.
Naziah Department of Paediatrics, Bolan Medical Complex Hospital, Quetta, Balochistan, Pakistan.
Arbab Nadeem Akhtar Department of Paediatrics, Bolan Medical Complex Hospital, Quetta, Balochistan, Pakistan.
Muhammad Hanif Department of Paediatrics, Bolan Medical Complex Hospital, Quetta, Balochistan, Pakistan.
Ghazala Habib Department of Paediatrics, Bolan Medical Complex Hospital, Quetta, Balochistan, Pakistan.

DOI:

https://doi.org/10.70749/ijbr.v3i3.845

Keywords:

Severe Malaria, Pediatric, Clinical Outcomes, Prognostic Factors

Abstract

Background: Malaria, caused by Plasmodium species, mainly affects African children, with P. falciparum being the deadliest strain. Severe cases lead to cerebral malaria, anemia, and organ dysfunction. Early diagnosis and artemisinin-based therapies improve outcomes, but healthcare limitations hinder effective management and treatment. Objectives: to examine the presentation features and laboratory profiles of severe malaria in children together with outcome tracking and mortality and morbidity predictive factors. The study findings will determine better treatment approaches to enhance patient care throughout malaria-endemic areas. Study design: A Retrospective Study. Place and duration of study. From December 2023 to May 2024 at Paediatrics Department Bolan Medical Complex Hospital Quetta. Methods: o n t h i s Descriptive Study that operated within a tertiary healthcare facility situated in an area with high rates of malaria. Medical staff reviewed admission records from patients under 15 years of age who received laboratory confirmation of severe malaria at the specified facility. Results: 136 children who had severe malaria received examination. The participant children had an average age of 5.2 years (standard deviation ± 2.8 years). The male-to-female ratio was 1.4:1. All patients manifested with fever during the study (100%) along with prostration in 82% of patients and severe anemia in 67% of patients and cerebral malaria in 48% of patients. Among the patients being studied 32 percent experienced respiratory distress symptoms. The laboratory analysis revealed mean results of 6.4 g/dL hemoglobin (SD ± 2.1, p = 0.03) with 4.6 mmol/L lactate (SD ± 1.9, p = 0.02) and 12.5% parasitemia (SD ± 5.6, p = 0.01). Conclusion: Severe malaria in children presents with anemia and neurological disorders. Despite treatment, high mortality persists, requiring better prevention and supportive care. Early diagnosis, artesunate therapy, and improved healthcare infrastructure can reduce disease burden and improve outcomes in endemic regions.

Downloads

Download data is not yet available.

References

Bittaye, S. O., Jagne, A., Jaiteh, L. E., Nadjm, B., Amambua-Ngwa, A., Sesay, A. K., Singhateh, Y., Effa, E., Nyan, O., & Njie, R. (2022). Clinical manifestations and outcomes of severe malaria in adult patients admitted to a tertiary hospital in the Gambia. Malaria Journal, 21(1). https://doi.org/10.1186/s12936-022-04294-4

Voloc, A., Kuissi Kamgaing, E., Ategbo, S., & Djoba Siawaya, J. F. (2022). Outcomes of severe malaria and its clinical features in gabonese children. Frontiers in Tropical Diseases, 3. https://doi.org/10.3389/fitd.2022.985890

Guinovart, C., Sigaúque, B., Bassat, Q., Loscertales, M. P., Nhampossa, T., Acácio, S., Machevo, S., Maculuve, S., Bambo, G., Mucavele, H., Soriano-Gabarró, M., Saifodine, A., Nhacolo, A., Nhalungo, D., Sacoor, C., Saúte, F., Aponte, J. J., Menéndez, C., Macete, E., … Alonso, P. L. (2022). The epidemiology of severe malaria at Manhiça district hospital, Mozambique: A retrospective analysis of 20 years of malaria admissions surveillance data. The Lancet Global Health, 10(6), e873-e881. https://doi.org/10.1016/s2214-109x(22)00125-5

Lendongo Wombo, J. B., Ibinga, E., Oyegue-Liabagui, S. L., Imboumy Limoukou, R. K., Okouga, A. P., Mounioko, F., Maghendji-Nzondo, S., Lekana-Douki, J. B., & Ngoungou, E. B. (2023). Severe malaria in children and adolescents in southeast Gabon. BMC Infectious Diseases, 23(1). https://doi.org/10.1186/s12879-023-08133-y

Namayanja, C., Eregu, E. E., Ongodia, P., Okalebo, C. B., Okiror, W., Okello, F., Okibure, A., Paasi, G., Kakungulu, H., Grace, A., Muhindo, R., Banks, D., Martin, C., Taylor-Robinson, S., & Olupot-Olupot, P. (2023). Unusual clinical spectra of childhood severe malaria during malaria epidemic in eastern Uganda: A prospective study. Malaria Journal, 22(1). https://doi.org/10.1186/s12936-023-04586-3

Imboumy-Limoukou, R. K., Lendongo-Wombo, J. B., Nguimbyangue-Apangome, A. F., Biteghe Bi Essone, J., Mounioko, F., Oyegue-Libagui, L. S., Ngoungou, B. E., & Lekana-Douki, J. (2023). Severe malaria in Gabon: Epidemiological, clinical and laboratory features in Amissa bongo hospital of Franceville. Malaria Journal, 22(1). https://doi.org/10.1186/s12936-023-04512-7

Olum, J., Mukunya, D., Nambozo, B., Nantale, R., Oguttu, F., Epuitai, J., Lume, I., Wanume, B., Olupot-Olupot, P., Amanya, D., & Kakuru, A. (2025). Severe malaria readmissions in northern Uganda: A cross-sectional study. Malaria Journal, 24(1). https://doi.org/10.1186/s12936-025-05307-8

Comelli, A., Guarner, M. E., Tomasoni, L. R., Fanetti Zamboni, A., Moreno Pavón, B., Zanotti, P., Caligaris, S., Matteelli, A., Soriano-Arandes, A., & Castelli, F. (2021). Severe imported plasmodium falciparum malaria in children: Characteristics and useful factors in the risk stratification. Travel Medicine and Infectious Disease, 44, 102196. https://doi.org/10.1016/j.tmaid.2021.102196

Song, X., Wei, W., Cheng, W., Zhu, H., Wang, W., Dong, H., & Li, J. (2022). Cerebral malaria induced by plasmodium falciparum: Clinical features, pathogenesis, diagnosis, and treatment. Frontiers in Cellular and Infection Microbiology, 12. https://doi.org/10.3389/fcimb.2022.939532

Kwambai, T. K., Mori, A. T., Nevitt, S., Van Eijk, A. M., Samuels, A. M., Robberstad, B., Phiri, K. S., & Ter Kuile, F. O. (2022). Post-discharge morbidity and mortality in children admitted with severe anaemia and other health conditions in malaria-endemic settings in Africa: A systematic review and meta-analysis. The Lancet Child & Adolescent Health, 6(7), 474-483. https://doi.org/10.1016/s2352-4642(22)00074-8

Teuwafeu, D. G., MaguipaTsasse, A. E., Puepi, Y. N., Ronald, G. M., Mbapah, T. L., Halle, M., & Ashuntantang, G. (2024). Aetiologies clinical presentation and outcome of acute kidney injury in children aged 29 days to 5 years: A two-year retrospective study. https://doi.org/10.21203/rs.3.rs-3929931/v1

Hauser, M., Kabuya, J. B., Mantus, M., Kamavu, L. K., Sichivula, J. L., Matende, W. M., Fritschi, N., Shields, T., Curriero, F., Kvit, A., Chongwe, G., Moss, W. J., Ritz, N., & Ippolito, M. M. (2022). Malaria in refugee children resettled to a Holoendemic area of sub-Saharan Africa. Clinical Infectious Diseases, 76(3), e1104-e1113. https://doi.org/10.1093/cid/ciac417

Watson, J. A., Uyoga, S., Wanjiku, P., Makale, J., Nyutu, G. M., Mturi, N., George, E. C., Woodrow, C. J., Day, N. P., Bejon, P., Opoka, R. O., Dondorp, A. M., John, C. C., Maitland, K., Williams, T. N., & White, N. J. (2022). Improving the diagnosis of severe malaria in African children using platelet counts and plasma Pf HRP2 concentrations. Science Translational Medicine, 14(654). https://doi.org/10.1126/scitranslmed.abn5040

Namazzi, R., Opoka, R., Datta, D., Bangirana, P., Batte, A., Berrens, Z., Goings, M. J., Schwaderer, A. L., Conroy, A. L., & John, C. C. (2022). Acute kidney injury interacts with coma, acidosis, and impaired perfusion to significantly increase risk of death in children with severe malaria. Clinical Infectious Diseases, 75(9), 1511-1519. https://doi.org/10.1093/cid/ciac229

Moffitt, C. A., Olupot-Olupot, P., Onen, J. W., & O’Brien, N. (2023). Adherence to severe malaria treatment guidelines in children at a ugandan regional hospital: A baseline assessment for a malaria treatment quality improvement project. Malaria Journal, 22(1). https://doi.org/10.1186/s12936-023-04507-4

Jamil, K. F., Pratama, N. R., Marantina, S. S., Harapan, H., Kurniawan, M. R., Zanaria, T. M., Hutagalung, J., Rozi, I. E., Asih, P. B., Supargiyono, & Syafruddin, D. (2021). Allelic diversity of merozoite surface protein genes (msp1 and msp2) and clinical manifestations of plasmodium falciparum malaria cases in Aceh, Indonesia. Malaria Journal, 20(1). https://doi.org/10.1186/s12936-021-03719-w

Ngai, M., Hawkes, M. T., Erice, C., Weckman, A. M., Wright, J., Stefanova, V., Opoka, R. O., Namasopo, S., Conroy, A. L., & Kain, K. C. (2022). Intestinal injury in ugandan children hospitalized with malaria. The Journal of Infectious Diseases, 226(11), 2010-2020. https://doi.org/10.1093/infdis/jiac340

Graham, H. R., Maher, J., Bakare, A. A., Nguyen, C. D., Ayede, A. I., Oyewole, O. B., Gray, A., Izadnegahdar, R., Duke, T., & Falade, A. G. (2021). Oxygen systems and quality of care for children with pneumonia, malaria and diarrhoea: Analysis of a stepped-wedge trial in Nigeria. PLOS ONE, 16(7), e0254229. https://doi.org/10.1371/journal.pone.0254229

Balanza, N., Francis, C. K., Crowley, V. M., Weckman, A. M., Zhong, K., Baro, B., Varo, R., Bassat, Q., & Kain, K. C. (2023). Neurofilament light chain as a biomarker of neuronal damage in children with malaria. The Journal of Infectious Diseases, 229(1), 296-297. https://doi.org/10.1093/infdis/jiad490

Weiland, A. S. (2023). Recent advances in imported malaria pathogenesis, diagnosis, and management. Current Emergency and Hospital Medicine Reports, 11(2), 49-57. https://doi.org/10.1007/s40138-023-00264-5