Journal of Tropical Pediatrics, 2015, 61, 272–278 doi: 10.1093/tropej/fmv029 Advance Access Publication Date: 8 May 2015 Original paper
Severe malaria in children: A descriptive report from Kinshasa, the Democratic Republic of Congo by Thomas S. Kunuanunua,1,2 Ce´lestin N. Nsibu,1 Joseph M. Bodi,1 The´re`se K. Tshibola,2 Mimy Makusi Bura,2 Kumbundu Magoga,2 Mathilde B. Ekila,3 Hypolite T. Situakibanza,3 and Michel N. Aloni4 1
Division of Intensive Care, Department of Pediatrics, University Hospital of Kinshasa, School of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo 2 Department of Pediatrics, Hoˆpital Ge´ne´ral de Re´fe´rence de N’djili, Institut Supe´rieur de Techniques Me´dicales, Kinshasa, Democratic Republic of Congo 3 Division of Infectious Diseases, Department of Internal Medicine, University Hospital of Kinshasa, School of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo 4 Division of Haemato-oncology and Nephrology, Department of Pediatrics, University Hospital of Kinshasa, School of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo Correspondence: Michel N. Aloni, Pediatric Nephrology Unit, Department of Pediatrics, University Hospital of Kinshasa, School of Medicine, University of Kinshasa, P.O. BOX 123 Kinshasa XI, Democratic Republic of Congo. E-mail
ABSTRACT The decline of susceptibility of Plasmodium falciparum to chloroquine and sulfadoxine–pyrimethamine resulted in the change of drug policy. This policy has probably changed the facies of the severe form of malaria. A prospective study was conducted in Kinshasa, the Democratic Republic of Congo. Data on children aged 13 years, diagnosed with severe malaria were analyzed. In total, 378 children were included with an overall median age of 8 years (age range: 1–13 years). Dark urine was seen in 25.1% of cases. Metabolic acidosis (85.2%), hypoglycemia (62.2%) and hemoglobin 5 g/dl (39.1%) were the common laboratories features. Severe malaria anemia, cerebral malaria and Blackwater fever (BWF) were found in 39.1, 30.1 and 25.4%, respectively. Mortality rate was 4%. BWF emerges as a frequent form of severe malaria in our midst. Availing artemisin-based combination treatments in the health care system is a priority to reduce the incidence of BWF in our environment. K E Y W O R D S : Plasmodium falciparum, severe malaria, Blackwater fever, children, drugs policy,
Kinshasa, Democratic Republic Democratic of Congo, Africa
INTRODUCTION Malaria is endemic and remains a major health public problem and takes its largest toll in children living in sub-Saharan countries. According to World Health Organization (WHO) global estimations in 2013, 528 000 [confidence interval (CI): 315 000–689 000]
malaria deaths occurred and 90% are estimated to be in children
Severe malaria in children: A descriptive report from Kinshasa, the Democratic Republic of Congo by Thomas S. Kunuanunua,1,2 Ce´lestin N. Nsibu,1 Joseph M. Bodi,1 The´re`se K. Tshibola,2 Mimy Makusi Bura,2 Kumbundu Magoga,2 Mathilde B. Ekila,3 Hypolite T. Situakibanza,3 and Michel N. Aloni4 1
Division of Intensive Care, Department of Pediatrics, University Hospital of Kinshasa, School of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo 2 Department of Pediatrics, Hoˆpital Ge´ne´ral de Re´fe´rence de N’djili, Institut Supe´rieur de Techniques Me´dicales, Kinshasa, Democratic Republic of Congo 3 Division of Infectious Diseases, Department of Internal Medicine, University Hospital of Kinshasa, School of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo 4 Division of Haemato-oncology and Nephrology, Department of Pediatrics, University Hospital of Kinshasa, School of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo Correspondence: Michel N. Aloni, Pediatric Nephrology Unit, Department of Pediatrics, University Hospital of Kinshasa, School of Medicine, University of Kinshasa, P.O. BOX 123 Kinshasa XI, Democratic Republic of Congo. E-mail
ABSTRACT The decline of susceptibility of Plasmodium falciparum to chloroquine and sulfadoxine–pyrimethamine resulted in the change of drug policy. This policy has probably changed the facies of the severe form of malaria. A prospective study was conducted in Kinshasa, the Democratic Republic of Congo. Data on children aged 13 years, diagnosed with severe malaria were analyzed. In total, 378 children were included with an overall median age of 8 years (age range: 1–13 years). Dark urine was seen in 25.1% of cases. Metabolic acidosis (85.2%), hypoglycemia (62.2%) and hemoglobin 5 g/dl (39.1%) were the common laboratories features. Severe malaria anemia, cerebral malaria and Blackwater fever (BWF) were found in 39.1, 30.1 and 25.4%, respectively. Mortality rate was 4%. BWF emerges as a frequent form of severe malaria in our midst. Availing artemisin-based combination treatments in the health care system is a priority to reduce the incidence of BWF in our environment. K E Y W O R D S : Plasmodium falciparum, severe malaria, Blackwater fever, children, drugs policy,
Kinshasa, Democratic Republic Democratic of Congo, Africa
INTRODUCTION Malaria is endemic and remains a major health public problem and takes its largest toll in children living in sub-Saharan countries. According to World Health Organization (WHO) global estimations in 2013, 528 000 [confidence interval (CI): 315 000–689 000]
malaria deaths occurred and 90% are estimated to be in children
