Ranque Stéphane, Poudiougou Belco, Traoré Abdoulaye, Keita Modibo, Oumar Aboubacar A, Safeukui Innocent, Marquet Sandrine, Cabantous Sandrine, Diakité Mahamadou, Mintha Daouda, Cissé Mahamadou B, Keita Marouf M, Dessein Alain J, Doumbo Ogobara K
Immunology and Genetics of Parasitic Diseases, Faculty of Medicine, Université de la Méditerrané, Marseilles, France.
Pediatr Infect Dis J. 2008 Feb;27(2):130-5. doi: 10.1097/INF.0b013e31815988ed.
The population exposed to malaria within African cities has steadily increased. However, comprehensive data on life-threatening malaria features and risk factors in children from urban areas with seasonal malaria transmission, such as in Bamako (Mali), are lacking.
Children admitted to the Gabriel Touré Hospital in Bamako with severe malarial anemia (SMA) and/or cerebral malaria (CM) were prospectively included in the study. Indicators of either SMA or CM were analyzed using logistic regression; and death hazard ratios (HRs) were estimated through survival analysis.
The study included 455 children: 66% presented with CM, 34% with SMA, 3% with hypoglycemia (HG); 5% with dehydration; 17% with respiratory distress (RD); 25% with splenomegaly; and 92% with hepatomegaly. The children with CM were older than those with SMA. CM was more often associated with dehydration, HG, and RD, whereas SMA was more often associated with splenomegaly. The overall case fatality rate was 16%, and 94% of the children who died had CM. HG [HR: 2.37; 95% confidence interval (CI): 1.04-5.39; P = 0.040], RD (HR: 4.23; 95% CI: 2.46-7.30; P < 10(-6)) and a deep coma with a Blantyre score of less than 3 (HR: 6.78, 95% CI: 2.43-18.91; P < 10(-3)), were all independent predictors of death.
These findings delineate the patterns of severe malaria in children in a West African mesoendemic urban setting. They validate practicable prognostic indicators of life-threatening malaria for use in the limited facilities available in African health centers and provide a frame of reference for further research addressing life-threatening malaria in this setting.
非洲城市中接触疟疾的人口一直在稳步增加。然而，缺乏关于季节性疟疾传播的城市地区儿童（如马里巴马科）危及生命的疟疾特征和危险因素的全面数据。
前瞻性纳入了在巴马科加布里埃尔·图雷医院因严重疟疾贫血（SMA）和/或脑型疟疾（CM）入院的儿童。使用逻辑回归分析SMA或CM的指标；并通过生存分析估计死亡风险比（HR）。
该研究纳入了455名儿童：66%为CM，34%为SMA，3%为低血糖（HG）；5%为脱水；17%为呼吸窘迫（RD）；25%为脾肿大；92%为肝肿大。CM患儿比SMA患儿年龄大。CM更常与脱水、HG和RD相关，而SMA更常与脾肿大相关。总体病死率为16%，死亡的儿童中有94%患有CM。HG[HR：2.37；95%置信区间（CI）：1.04 - 5.39；P = 0.040]、RD（HR：4.23；95% CI：2.46 - 7.30；P < 10(-6)）以及布兰太尔评分低于3的深度昏迷（HR：6.78，95% CI：2.43 - 18.91；P < 10(-3)），均为死亡的独立预测因素。
这些发现描绘了西非中度流行城市环境中儿童严重疟疾的模式。它们验证了可用于非洲卫生中心有限设施的危及生命疟疾的可行预后指标，并为在这种环境下进一步研究危及生命的疟疾提供了参考框架。
