Table 1.

Case Definitions for Severe Malaria Syndromes

	WHO Definition [1, 2]	Definition Used in Present Study
Impaired consciousness	Blantyre coma score <3 in children; cerebral malaria is defined as a coma persisting for >30 minutes after a seizure	2 definitions of cerebral malaria used: cerebral malaria 1 was defined as being unconscious, as measured on the AVPU scale (AVPU score = U); cerebral malaria 2 was defined as a child responding only to pain or being unconscious (AVPU score = U or P); children with AVPU score = V were also considered to have severe malaria
Prostration	Inability to sit if normally able to sit or inability to breastfeed if previously not sitting	Inability to drink or breastfeed but fully alert (AVPU score = A) used as proxy for prostration
Acidosis, respiratory distress	A base deficit of >8 meq/l, plasma bicarbonate of <15 mM, venous plasma lactate >5 mM, or severe acidosis manifesting clinically as respiratory distress, defined as rapid, deep, and labored breathing	Chest indrawing or deep/acidotic breathing on examination
Severe malarial anemia	A hemoglobin concentration <5 g/dl or a hematocrit of <15% in children <12 years of age, together with a parasite count >10 000/µl	Defined as hemoglobin ≤5 g/dl in the presence of any malaria parasitemia (parasite count not done). If the hemoglobin level was not documented, then severe anemia was also defined as any of the following: clinical diagnosis of severe anemia, documented severe palmar pallor, or transfusion given or prescribed
Multiple convulsions	More than 2 episodes within 24 hours	Same definition

Abbreviations: A, alert; AVPU, alert, response to voice, response to pain, unconscious scale; P, responsive to pain; U, unconscious; V, responsive to a voice; WHO, World Health Organization.