Abstract:
Background: Paucity of data on the role of parasite density on clinical manifestations of
severe malaria and their outcomes in children has been noted. This study aimed at ascertaining the role of parasite density in influencing the manifestations and outcomes of
clinically severe malaria in children in Mbale, Eastern Uganda. Methods: A cross sectional study was conducted to determine the parasite density, clinical spectrum, and outcomes of severe Plasmodium falciparum malaria at Mbale Regional Referral Hospital, Eastern Uganda. Children aged 2 months to 12 years were recruited after confirmation of positive P. falciparum malaria on microscopy and consent. Approval was obtained from MRRH REC. Results: A total of 377 children were recruited with 76.9 % (290/377) presenting with
prostration, 55.4% (209/377) jaundice, 48.5% (183/377) severe anaemia, and 46.7%
(176/377) haemoglobinuria (dark or black urine) with 67.6 % above 5. Cerebral malaria
constituted 7.4% (28/377) with 64.3% under 5, 23.1% (87/377) impaired consciousness,
8.2% (31/377) respiratory distress, 15.4% (58/377) acidosis, and 13.8 % (52/377) renal
impairment. Majority had greater than 1 clinical form of severe malaria (88.33 %).
Hyperparasitaemia constituted 19.1% (72/377), 30.6% being under 5. Mean parasite
density was 136000 parasites/µl. Hyperparasitaemia was associated with
thrombocytopenia AOR (95% Cl) 2.07(1.04, 4.13), p-0.039 and neutropenia AOR
2.31(1.1, 4.89), p-0.028. In hospital mortality was 3.4% (12/357) with 66.7% under 5.
Case fatality due to hyperparasitaemia was 25%. Mortality was associated with deep
acidotic breathing AOR (95% Cl) 8.0(1.0, 62.8) p-0.047 and renal impairment/failure
AOR (95% Cl) 6.0(1.1, 34.4) p-0.044. Prolonged hospital stay was in 18 %( 68/377). No
independent association was found between parasitaemia and mortality. Conclusions: Severe malaria’s still endemic in Eastern Uganda with case fatality rate of 3.4 %. Mean parasitic density was 136000 parasites/µl, and was not associated with mortality. Increase of cerebral malaria in <5, and haemoglobinuria in > 5 was noted. Dark urine was associated with renal impairment which was associated with mortality. This warrants more investigation.
Keywords: Severe malaria, Hyperparasitaemia, Parasite density, severe anaemia,
haemoglobinuria, Dark or black urine, renal impairment, P. falciparum malaria, Children,
Uganda.
