Childhood Cerebral Malaria in Nigeria: Clinical Features, Treatment and Outcome
Samuel O. Oninla *
Department of Paediatrics, Ladoke Akintola University of Technology, Ogbomoso, Nigeria and Department of Paediatrics, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria.
Paul S. Ogunro
Department of Chemical Pathology, Ladoke Akintola University of Technology, Ogbomoso, Nigeria.
Olumayowa A. Oninla
Department of Dermatology and Venereology, Obafemi Awolowo University, Ile-Ife, Nigeria.
Olamide V. Kayode
Department of Paediatrics, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria.
*Author to whom correspondence should be addressed.
Abstract
Aims: The study aimed at reviewing the clinical features, treatment and outcome of childhood cerebral malaria in a Nigerian health facility, to improve its management and outcome.
Study Design: It is a retrospective study of cerebral malaria patients.
Place and Duration of Study: Department of Paediatrics, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria, between September 2011 and August 2012.
Materials and Methods: Hospital records of children managed for cerebral malaria during the study period were retrieved and assessed. Information extracted from the records was: bio-data, anthropometric values, clinical and laboratory findings, treatment modality, outcome and duration of hospital stay. SPSS version 19 software was used to analyze the data.
Results: We studied 20 patients. The age range was 7 to 99 months (mean 43.3±25.2), and under-five children accounted for 75% of the patients. Mean admission weight was 12.8±4.0, with percentage weight for age mean of 84.5% ±11.2. More well-nourished (normal weight) patients (12) than underweight (8) were affected, and the difference of their means percentage weight for age was significant (P = .00). The principal complaints were: fever, convulsion and loss of consciousness. The mean packed cell volume at presentation in the hospital was 23.9%±8.0, and nine patients (45%) had blood transfusion. A large proportion of the patients had electrolytes, urea and glucose abnormalities. Plasmodium falciparum was the only parasite specie found in the blood films of all the patients, and all cerebrospinal fluid results were normal. Nineteen (95%) patients received parenteral artemisinin derivatives. Five (25%) patients had their antimalarial changed to quinine. Fifty-five percent had a full recovery, 30% were discharged with neurological deficits, 10% discharged against medical advice, and 5% died. Neurological sequelae were found to be more among underweight children and those who were given artemisinin and amodiaquine combination. The outcome appeared to depend on the age of the patient, sex, type of antimalarial given, nutritional status, abnormal laboratory results and illness duration before presentations at the hospital. Mean hospital stay was 10.4±7.9 days.
Conclusion: The use of parenteral artemisinin derivatives or quinine infusion only, rather than artemisinin and amodiaquine combination drugs at the outset of CM management, improvement in children nutrition and regular malaria parasitaemia monitoring during therapy will go a long way to reducing morbidity and mortality among CM patients in Nigeria.
Keywords: Childhood, cerebral malaria, features, treatment, outcome.