Severe malaria in children in Yemen: two site observational study

doi:10.1136/bmj.38959.368819.BE

BMJ 2006;333:827 (21 October), doi:10.1136/bmj.38959.368819.BE

Research

Severe malaria in children in Yemen: two site observational study

Abdullah Al-Taiar, lecturer¹, Shabbar Jaffar, reader in statistics², Ali Assabri, professor¹, Molham Al-Habori, professor¹, Ahmed Azazy, professor¹, Nagiba Al-Mahdi, paediatrician³, Khaled Ameen, paediatrician³, Brian M Greenwood, professor², Christopher J M Whitty, professor²

¹ Faculty of Medicine and Health Sciences, Sana'a University, PO Box 13078, Sana'a, Yemen, ² Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, ³ Yemeni-Swedish Hospital, Taiz, Yemen

Correspondence to: A Al-Taiar a_m_altaiar{at}yahoo.com

Abstract

Objectives To assess the burden of malaria on health services,describe the clinical presentation of severe malaria in children,and identify factors associated with mortality by means of aprospective observational study.

Setting Two public hospitals in Taiz (mountain hinterland) andHodeidah (coastal plain), Yemen.

Participants Children aged 6 months to 10 years.

Results Of 12 301 paediatric admissions, 2071 (17%) were forsuspected severe malaria. The proportion of such admissionsvaried according to the season (from 1% to 40%). Falciparummalaria was confirmed in 1332 children; 808 had severe diseaseas defined by the World Health Organization. Main presentationswere respiratory distress (322/808, 40%), severe anaemia (291/800,37%), and cerebral malaria (60/808, 8%). Twenty two of 26 childrenwho died had a neurological presentation. No deaths occurredin children with severe anaemia but no other signs of severity.In multivariate analysis, a Blantyre coma score $≤$ 2, historyof fits, female sex, and hyperlactataemia predicted mortality;severe anaemia, respiratory distress, and hyperparasitaemiawere not significant predictors of mortality.

Conclusions Severe malaria puts a high burden on health servicesin Yemen. Although presentation is similar to African series,some important differences exist. Case fatality is higher ingirls.

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Neurological presentation of malaria in Yemen has poor prognosis
BMJ 2006 333: 0. [Full Text]

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Rapid Responses:

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Severe falciparum malaria in Yemen: Child case fatality is 4 times higher in highlands compared with endemic areas.: Salem Banajeh
bmj.com, 23 Oct 2006 [Full text]
Why?: Michael E Reschen
bmj.com, 24 Oct 2006 [Full text]
Editor's reply: Fiona Godlee
bmj.com, 25 Oct 2006 [Full text]
Re: Editor's reply: Michael E Reschen
bmj.com, 25 Oct 2006 [Full text]
Importance of neurological presentation of malaria in Africa: Nicholas AV Beare
bmj.com, 1 Nov 2006 [Full text]