POOR PROGNOSIS IN CEREBRAL MALARIA OCCURRING IN CHILDREN SEEN AT THE UNIVERSITY OF ILORIN TEACHING HOSPITAL, ILORIN

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POOR PROGNOSIS IN CEREBRAL MALARIA OCCURRING IN CHILDREN SEEN AT THE UNIVERSITY OF ILORIN TEACHING HOSPITAL, ILORIN

Abstract

Cerebral malaria (CM) is a lethal form of severe malaria with generally poor
prognostic outcome among children in the tropics. The most common clinical features
include high fever, profound loss of consciousness and convulsions. Several other
compounding features identified by many investigators which are suggested to
contribute to poor prognosis include age (under 3 years), hypoglycaemia, profound
coma, multiple or prolonged seizures, hyperparasitaemia, metabolic acidosis, shock,
severe anaemia, decerebration, respiratory distress, retinal haemorrhages, and absent
corneal reflex. The most acclaimed pathophysiology of CM is the mechanical
hypothesis, which postulates that: parasitized red blood cells (PRBCs) have decreased
deformability, which impairs their ability to traverse capillaries, increased
cytoadherence and microcirculatory obstruction. Univariate analyses of the data
emerging from most of these previous studies were insufficiently discriminatory to
permit the identification of the features that are critically predictive of poor outcome
in CM. This study adopts the multivariate analysis of data, which permit
determination of the independent factors most likely to be predictive of poor outcome.
One hundred and two children aged five years and below who presented with cerebral
malaria defined according to the protocol were recruited into the study. There were 57
males and 45 females, with a male: female ratio of 1.3: 1. The case fatality rate (CFR)
was 14. 7%. Of the 85.3% survivors, 55.9% recovered fully, while 29.4% had
neurological sequelae. Observed sequelae included cortical blindness in 12.8%, loss of
neck control, 8.8%; Para paresis, 3.9%; aphasia, hyperactivity, ataxia each in 2.9% of
cases, behavioural disorder, recurrent seizure and hemiparesis each in 1.9% while
deafness was observed in one patient. Fifty percent of deaths occurred within 24 hours
of admission and of the total deaths, 73.3% were aged less than 3 years. Thus, the risk
of death or neurological sequelae among this group was significantly higher compared with children above 3 years of age {χ2 = 11.18, p = 0.0008, RR = 4.5 (95% CI 1.6 –
12)}. Other poor prognostic factors were; multiple convulsions, prostration, use of
cow’s urine concoction, abnormal respiration, jaundice, deep coma, presence of retinal
haemorrhages, absence of corneal reflex, high mean parasite density, high WBC count
and severe anaemia. However, only retinal haemorrhages, absent corneal reflex and
deep coma were significant independent predictors of poor prognosis.
In conclusion, CM remains a significant cause of death and neurological sequelae with
independent factors predictive of poor outcome being deep coma, absent corneal
reflex and retinal haemorrhages.

POOR PROGNOSIS IN CEREBRAL MALARIA OCCURRING IN CHILDREN SEEN AT THE UNIVERSITY OF ILORIN TEACHING HOSPITAL, ILORIN

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