Severe P. falciparum malaria in Kenyan children: evidence for hypovolaemia

QJM. 2003 Jun;96(6):427-34. doi: 10.1093/qjmed/hcg077.


Background: The role of volume resuscitation in severe Plasmodium falciparum malaria is controversial.

Aim: To examine the role of hypovolaemia in severe childhood malaria.

Study design: Retrospective review.

Methods: We studied 515 children admitted with severe malaria to a high-dependency unit (HDU) in Kilifi, Kenya. On admission to the HDU, children underwent a further assessment of vital signs and a standard clinical examination.

Results: Factors associated with a fatal outcome included deep breathing or acidosis (base excess below -8), hypotension (systolic blood pressure <80 mmHg), raised plasma creatinine (>80 micro mol/l), low oxygen saturation (<90%), dehydration and hypoglycaemia (<2.5 mmol/l). Shock was present in 212/372 (57%) children, of whom 37 (17.5%) died, and was absent in 160, of who only 7 (4.4%) died (chi(2) = 14.9; p = 0.001).

Discussion: Impaired tissue perfusion may play a role in the mortality of severe malaria. Moreover, volume resuscitation, an important life-saving intervention in children with hypovolaemia, should be considered in severe malaria with evidence of impaired tissue perfusion.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acidosis / drug therapy*
  • Acidosis / etiology*
  • Blood Transfusion / methods
  • Child
  • Child, Preschool
  • Female
  • Fluid Therapy / methods
  • Humans
  • Hypovolemia / complications*
  • Hypovolemia / drug therapy*
  • Infant
  • Infant, Newborn
  • Kenya / epidemiology
  • Malaria, Falciparum / complications*
  • Malaria, Falciparum / mortality
  • Male
  • Retrospective Studies
  • Survival Rate