Severe malaria in children in Papua New Guinea

The clinical features of severe falciparum malaria and risk factors formortality were studied in 489 children admitted with malaria to MadangHospital, Papua New Guinea. The most common severe manifestations ofmalaria were severe anaemia (22%) and coma (16%). Children with severeanaemia were younger than those with coma (median age 2.2 vs. 3.7 years)and had been ill for longer before admission (median 7 vs. 4 days,respectively). Although the clinical features of coma in Madang childrenwith malaria resembled closely those reported in African children,mortality was lower (8% vs. 17-25%, respectively). Overall, 17 (3.5%)children died, most within 12 h of admission. A high level of plasmalactate (> or = 5 mmol/l) was common (20%) and was the major predictorof death in multiple regression analysis. Raised plasma creatinine anddecreased plasma bicarbonate were also independent predictors of mortality.Coma was not predictive of death, although a high proportion of childrenwith profound coma died. Investigation of the causes of acidosis inchildren with malaria is a high research priority. In view of the shorttime interval between admission and death in many children, emphasis mustbe placed on the prevention or early recognition and treatment of acidosisin the district health clinic as well as the central hospital.