Table 1.
Demographic and Clinical Characteristics of Children with Malaria, Stratified by Severity Grouping
| Severe Malariaa | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| Characteristics | All severe malaria patients | CM | SMA | RD | Other | Uncomplicated Malaria |
P Valueb | Asymptomatic Malaria | P Valuec |
| Total, no. (%) | 1521 (100) | 881 (58.0) | 335 (22.0) | 477 (31.4) | 330 (21.7) | 198 (100) | NA | 28 (100) | NA |
| Female sex, no. (%) | 753 (49.5) | 442 (50.2) | 171 (51.0) | 232 (48.6) | 154 (46.7) | 92 (46.5) | <.001 | 7 (35.0) | <.001 |
| Age, (median, IQR), y | 2.4 (1.4–3.7) | 2.3 (1.4–3.6) | 1.7 (0.8–2.5) | 2.2 (1.3–3.3) | 2.8 (1.8–4.7) | 3.1 (1.9–4.3) | <.001 | 7.6 (6.5–9.5) | <.001 |
| WAZ score, mean (SD) | –1.9 (1.3) | –1.9 (1.3) | −2.1 (1.2) | −1.9 (1.4) | −1.7 (1.2) | −1.7 (0.9) | .12 | NA | NA |
| HAZ score, mean (SD) | −1.4 (1.8) | −1.3 (1.7) | −1.5 (1.8) | −1.4 (1.9) | −1.4 (1.7) | −1.5 (1.2) | .53 | NA | NA |
| Prostration (BCS score, 3 or 4), no. (%) | 271/1484 (18.3) | 0/881 (0) | 36/317 (11.4) | 89/472 (18.9) | 169/315 (53.7) | 0 (0) | <.001 | NA | NA |
| Coma (BCS score <3), no. (%) | 881/1484 (59.4) | 881/881 (100) | 151/317 (47.6) | 317/472 (67.2) | 0/315 (0) | 0 (0) | <.001 | NA | NA |
| Hemoglobin, mean (SD), g/dL | 7.0 (2.5) | 7.2 (2.4) | 3.7 (0.9) | 6.8 (2.6) | 7.8 (2.0) | 8.9 (1.6) | <.001 | 11.3 (1.2) | <.001 |
| Hematocrit, mean (SD), % | 22.1 (7.8) | 23.0 (7.5) | 11.8 (2.8) | 21.4 (8.0) | 24.6 (6.3) | 27.5 (4.7) | <.001 | NA | NA |
| Severe anemia (Hb <5 g/dL), no. (%) | 335 (22.0) | 151 (17.1) | 335 (100) | 122 (25.3) | 0 (0) | 0 (0) | <.001 | NA | NA |
| RD, no. (%) | 477 (31.5) | 317 (36.2) | 122 (36.4) | 477 (100) | 0 (0) | 50 (25.1) | <.001 | NA | NA |
| Hypoglycemia, no. (%) | 187 (12.3) | 126 (14.3) | 59 (17.6) | 95 (19.9) | 13 (3.9) | 8 (4.0) | <.001 | NA | NA |
| Base deficit, mean (SD), mmol/L | −10.5 (6.2) | −10.6 (5.9) | −13.1 (7.0) | −13.4 (6.4) | −7.5 (5.4) | −4.1 (4.1) | <.001 | NA | NA |
| Severe acidosis (BD <8 mmol/L), no (%) | 766/1238 (61.8) | 471/720 (65.4) | 196/260 (75.3) | 319/400 (79.7) | 111/275 (40.3) | 24/176 (13.6) | <.001 | NA | NA |
| IBI, no. (%)d | 50 (3.3) | 26 (2.9) | 15 (4.5) | 10 (2.1) | 12 (3.6) | 1 (0.5) | .02 | NA | NA |
| Hyperparasitemia, no. (%) | 454 (29.8) | 266 (30.0) | 80 (23.8) | 169 (35.4) | 93 (28.1) | 79 (39.9) | .004 | NA | NA |
| In-hospital death, no. (%) | 178 (11.7) | 128 (14.5) | 47 (14.0) | 79 (16.5) | 16 (4.8) | 0 (0) | <.001 | NA | NA |
Abbreviations: BCS, Blantyre coma scale; CM, cerebral malaria; HAZ score, height-for-age z score; Hb, hemoglobin; IBI, invasive bacterial infection; IQR, interquartile range; NA, not available or not applicable; RD, respiratory distress; SD, standard deviation; SMA, severe malarial anemia; WAZ score, weight-for-age z score.
aSome children with severe malaria manifest >1 clinical feature of severity.
bBetween uncomplicated and all severe malaria.
cBetween asymptomatic and all severe malaria.
dThe following organisms grew in cultures from patients with severe malaria: Enterobacter cloacae (n = 1), Escherichia coli (n = 4), Haemophilus influenzae (n = 3), Neisseria species (n = 1), Pseudomonas species (n = 4), Shigella sonnei (n = 1), nontyphoidal Salmonella species (n = 11), Staphylococcus aureus (n = 4), group A Streptococcus (n = 4), Streptococcus pneumoniae (n = 16), and Streptococcus viridans (n = 1). S. viridans was cultured from a patient with uncomplicated malaria (n = 1). All IBI organisms were grown from blood cultures, except for a single S. pneumoniae infection that was detected in cerebrospinal fluid only.