Prostration and the prognosis of death in African children with severe malaria

Journal article

Objectives: Malaria is still one of the main reasons for hospitalization in children living in sub-Saharan Africa. Rapid risk stratification at admission is essential for optimal medical care and improved prognosis. Whereas coma, deep breathing, and, to a lesser degree, severe anemia are established predictors of malaria-related death, the value of assessing prostration for risk stratification is less certain.

Methods: Here we used a retrospective multi-center analysis comprising over 33,000 hospitalized children from four large studies, including two observational studies from the Severe Malaria in African Children network, a randomized controlled treatment study, and the phase-3-clinical RTS,S-malaria vaccine trial, to evaluate known risk factors of mortality and with a specific emphasis on the role of prostration.

Results: Despite comparable age profiles of the participants, we found significant inter- and intra-study variation in the incidence of fatal malaria as well as in the derived risk ratios associated with the four risk factors: coma, deep breathing, anemia, and prostration. Despite pronounced variations, prostration was significantly associated with an increased risk of mortality (P <0.001) and its consideration resulted in improved predictive performance, both in a multivariate model and a univariate model based on the Lambaréné Organ Dysfunction Score.

Conclusion: Prostration is an important clinical criterion to determine severe pediatric malaria with possible fatal outcomes.

Authors: Agnandji, ST; Recker, M; Mordmüller, B; Glöckner, S; Adegnika, AA

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Elsevier
• Journal: International Journal of Infectious Diseases
• Volume: 134
• Pages: 240-247
• Place of publication: Canada
• Publication date: 2023-07-04
• Acceptance date: 2023-06-29
• DOI: 10.1016/j.ijid.2023.06.022
• ISSN: 1201-9712
• Pmid: 37414210
• Language: English
• Keywords: mortality; coma; severe malaria; prostration; deep breathing