Predictors of fatal outcome of severe malaria in children of Bhopal, central India: Retrospective study

Abstract

Objective: To identify predictors of fatal outcome of severe malaria in children admitted to a tertiary care centre. Method: This retrospective study was performed at a tertiary health care institution which is a low transmission area of malaria. Confirmed malaria patients (P. falciparum, P. vivax or mixed infection) satisfying one or more of the 2010 WHO criteria for severe malaria were included in the study. Prevalence of fatal outcome due to major symptoms was calculated followed by univariate regression analysis to identify major predictors of fatal outcome. Results: A total of 102 children satisfied WHO criteria of severe malaria and were included in the study. Fatal outcome was seen in 14 children and girls (71.4%; 10/14) were more affected as compared to boys (p<0.05). The risk of fatal outcome was higher (71.4%; 10/14) among older children (>7years) but this was not a predicting factor for fatal outcome (p>0.05). Fatal outcome was seen more in children with falciparum infestation (78.5%; 11/14) but this was insignificant (p>0.05). Univariate regression analysis identified impaired consciousness (p<0.05, RR-0.25, CI-0.10-0.65), shock (p<0.001, RR-0.12, CI-0.052-0.28), spontaneous bleeding (p<0.001, RR-0.08, CI-0.04-0.16), multisystem involvement (p<0.05, RR-0.23, CI-0.06-0.78), gastrointestinal dysfunction (p<0.05, RR-0.37,CI- 0.14-0.99), renal failure (p<0.05, RR-1.54, CI-0.81- 2.95) and respiratory distress (p<0.001, RR-0.17 ,CI- 0.07-0.40) as predictors of fatal outcome. Severely anaemic children of severe malaria hardly ever had fatal outcome (p<0.05). Conclusions: Impaired consciousness, shock, spontaneous bleeding, multisystem involvement, gastrointestinal dysfunction, renal failure and respiratory distress were predictors of fatal outcome of severe malaria in children admitted to the tertiary care centre.