Adigun Mahfuz Babatunde, Alao Michael Abel, Akindolire Abimbola Ellen, Suleiman Bello Mohammed, Ibrahim Olayinka Rasheed
Department of Pediatrics, University College Hospital, Ibadan, Oyo State, Nigeria.
Department of Pediatrics, College of Medicine University of Ibadan & University. College Hospital, Ibadan, Oyo State, Nigeria.
Med J Armed Forces India. 2025 May-Jun;81(3):282-290. doi: 10.1016/j.mjafi.2023.09.011. Epub 2023 Nov 3.
Severe malaria (SM) has remained a major global health challenge, disproportionately affecting children in endemic areas. Understanding the factors that influence childhood SM outcomes is critical for developing contextualized early warning scores, effective prevention, and treatment strategies.
This is a retrospective, multicenter study conducted between year 2019 and 2022 involving children diagnosed with SM based on World Health Organization (WHO) diagnostic criteria. Multivariate logistic regression was used to identify the determinants of in-hospital mortality from significantly associated factors on bivariate analysis.
Of the 7765 children admitted to emergency rooms, 997 (12.8%) had SM, with a median age of 4 (IQR: 2.7). M: F ratio of 1.2:1. Anemia (353: 35.4%), hemoglobinuria (348: 34.9%), cerebral malaria (331: 33.1%), and prostration (325: 32.6%) were the most common manifestations of SM. Half (494, 49.5%) of the children had only one form of SM, followed by a combination of three forms (270: 27.1%) of SM. Nine of 43 children with severe acute kidney injury received peritoneal dialysis, while 19 received haemodialysis. Severe shock (75.0%) and a patient with respiratory distress syndrome received mechanical ventilation support. The determinants of increased mortality included the first day of admission [OR (95% CI):24.44 (9.792, 61.007)], and manifestations of shock with a 17-fold [OR (95% CI): 17.682 (4.159, 75.196)] increased mortality.
SM still carries a significant risk of increased mortality, the need for dialysis, and mechanical ventilation support. The first 24 h after admission, as well as the shock, are determinants of increased mortality.
重症疟疾仍然是一项重大的全球卫生挑战，对流行地区的儿童影响尤为严重。了解影响儿童重症疟疾结局的因素对于制定因地制宜的早期预警评分、有效的预防和治疗策略至关重要。
这是一项回顾性多中心研究，于2019年至2022年期间开展，纳入了根据世界卫生组织（WHO）诊断标准确诊为重症疟疾的儿童。采用多变量逻辑回归从双变量分析中的显著相关因素中确定院内死亡的决定因素。
在7765名入住急诊室的儿童中，997名（12.8%）患有重症疟疾，中位年龄为4岁（四分位间距：2.7），男女性别比为1.2:1。贫血（353例：35.4%）、血红蛋白尿（348例：34.9%）、脑型疟疾（331例：33.1%）和极度虚弱（325例：32.6%）是重症疟疾最常见的表现。半数（494例，49.5%）儿童仅有一种重症疟疾形式，其次是三种形式组合（270例：27.1%）的重症疟疾。43例严重急性肾损伤患儿中有9例接受了腹膜透析，19例接受了血液透析。严重休克患儿（75.0%）和1例呼吸窘迫综合征患儿接受了机械通气支持。死亡率增加的决定因素包括入院首日[比值比（95%置信区间）：24.44（9.792，61.007）]，以及休克表现使死亡率增加17倍[比值比（95%置信区间）：17.682（4.159，75.196）]。
重症疟疾仍然具有死亡率增加、需要透析和机械通气支持的重大风险。入院后的最初24小时以及休克是死亡率增加的决定因素。
