Clinical features and determinants of outcome of children admitted with malaria at Kenyatta National Hospital
Otieno, Godfrey A
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Background: The clinical manifestations of malaria depend on the immune status of the host, age and transmission intensity. Several studies across Africa have looked at clinical features of severe malaria at different transmission settings. Nairobi is thought to be a low transmission area for malaria. Various clinical features and laboratory findings have been shown to affect outcome in children with malaria in endemic areas. However, these have not been described in areas of low transmission in Kenya. We aimed to describe the clinical features, laboratory profiles and determinants of outcome of children admitted with malaria at Kenyatta National Hospital (KNH) a national referral and teaching hospital in Nairobi. Objective: To describe the pattern of clinical and laboratory features and determinants of outcome in children admitted with a diagnosis of malaria to the general paediatric wards of Kenyatta National Hospital. Design: Cross sectional descriptive study at the general paediatric wards of KNH. Methods: Using a standardised questionnaire, information on socio-demography and symptomatology was obtained. Physical examination was carried out on the children and venous blood drawn for analysis of malaria parasitemia, haeomoglobin, white blood cell count and blood glucose. Follow up was done on days 1, 3 and on discharge where outcome was determined. Outcome measures were, Malaria with complications, No complications and Death. Study Period: 24th January 2007 to 15th November 2007. Results: A total of 94 patients were recruited, 51 (54.3%) being females. The median age was 22 months. Fifty five (58.5%) of the children had history oftravel out of Nairobi prior to the illness. The mean (s.d.) duration of illness prior to admission was 4.3 (2.9) days. Fever was the most common presenting symptom noted in 97.7% of the children. The mean (s.d) Hb was 7.3 (3.0) g/dl. Hypogylcaemia was observed in 5 (5.3%) of the children. Overall there were 6 (6.4%) deaths, while 36 (38.3%) and 52 (55.3%) had malaria with complications and no complications respectively. The only factor associated with fatal outcome was deep acidotic breathing p = 0.01 (95% CI 1.3 - 93.6). Overall 28.7% (27/94) fulfilled at least one criteria for the paediatric severe malaria syndrome. Both respiratory distress and severe malarial anaemia were the most common at 28.7% and 26.6% respectively, with impaired consciousness observed in 14.8% ofthe children. Conclusion: Majority of children admitted to KNH with malaria presented with the previously described syndromic malaria symptomatology with 26.6% being severe anaemia, while deep acidotic breathing being the only factor associated with fatal outcome. Recommendation: Proper clinical characterization of children admitted to KNH with a diagnosis of malaria will assist in identifying those at risk of death due to malaria.