The clinical spectrum of severe childhood malaria in Eastern Uganda
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laria Journal Open Access
RESEARCH
The clinical spectrum of severe childhood malaria in Eastern Uganda Peter Olupot‑Olupot1,2*, Charles Engoru3, Julius Nteziyaremye1,2, Martin Chebet1,2, Tonny Ssenyondo2, Rita Muhindo2, Gideon Nyutu4, Alexander W. Macharia4, Sophie Uyoga4, Carolyne M. Ndila4, Charles Karamagi5, Kathryn Maitland4,6 and Thomas N. Williams4,6
Abstract Background: Few recent descriptions of severe childhood malaria have been published from high-transmission regions. In the current study, the clinical epidemiology of severe malaria in Mbale, Eastern Uganda, is described, where the entomological inoculation rate exceeds 100 infective bites per year. Methods: A prospective descriptive study was conducted to determine the prevalence, clinical spectrum and outcome of severe Plasmodium falciparum malaria at Mbale Regional Referral Hospital in Eastern Uganda. All children aged 2 months–12 years who presented on Mondays to Fridays between 8.00 am and 5.00 pm from 5th May 2011 until 30th April 2012 were screened for parasitaemia. Clinical and laboratory data were then collected from all P. falciparum positive children with features of WHO-defined severe malaria by use of a standardized proforma. Results: A total of 10 208 children were screened of which 6582 (64%) had a positive blood film. Of these children, 662 (10%) had clinical features of severe malaria and were consented for the current study. Respiratory distress was the most common severity feature (554; 83.7%), while 365/585 (62.4%) had hyperparasitaemia, 177/662 (26.7%) had clinical jaundice, 169 (25.5%) had severe anaemia, 134/660 (20.2%) had hyperlactataemia (lactate ≥ 5 mmol/L), 93 (14.0%) had passed dark red or black urine, 52 (7.9%) had impaired consciousness and 49/662 (7.4%) had hypoxae‑ mia (oxygen saturations 2 episodes in the 24 h period prior to admission. Respiratory distress was defined as increased work of breathing manifesting as deep, fast or very slow breathing, including retractions and the use of accessory muscles. Spontaneous bleeding was defined as physically un-induced and irrepressible bleeding from at least two non-traumatized sites in a
Table 1 Criteria used as indicators of severe malaria in the study Clinical criteria
Definition
Clinical jaundice
Yellow mucous membranes noted in sufficient daylight
Respiratory distress
Increased work of breathing, manifesting as deep, fast or very slow breathing, including retractions and the use of accessory muscles
Severe anaemia
Haemoglobin 5 mmol/L
Hyperparasitaemia
>5% parasitized erythrocytes or > 250 000 parasites/μL
Hyperpyrexia
Axillary temperature ≥ 40.0°C
Hypoxaemia
Oxygen saturation
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