The predictors of outcome of cerebral malaria among children in Nigeria tertiary health facility

Jegede, Tolulope; Oseni, Saheed; Okeniyi, Akintunde; Kuti, Bankole; Adegoke, Samuel; Salau, Olakunle; Alonge, Abel; Fasoranti, Ifedayo; Bello, Olaseinde; KAREEM, ABIODUN J; Jegede, Temitope; Olatunya, Oladele; Oyelami, Oyeku; Oluwatuyi, Korede; Obasohan, Stanley; Abazu, Ikechukwu; Babalola, Emmanuel; Eniowo, Patricia

doi:10.21608/mid.2024.292832.1970

The predictors of outcome of cerebral malaria among children in Nigeria tertiary health facility

Document Type : Original Article

Authors

¹ Department of Paediatrics, Federal Medical Centre, Owo, Ondo state, Nigeria

² Department of Paediatrics and Child Health, Obafemi Awolowo University, Ile-Ife, Osun state, Nigeria

³ Department of Paediatrics and Child Health Obafemi Awolowo University, Ile Ife

⁴ Department of Paediatrics, University of Medical Sciences Teaching Hospital Akure, Ondo state, Nigeria

⁵ Department of Psychiatry, Federal Neuropsychiatry Hospital, Uselu, Benin City, Edo state, Nigeria

⁶ Department of Paediatrics, Ekiti State University, Ado-Ekiti, Ekiti-State, Nigeria

⁷ Department of Paediatrics, Mother and Child Hospital, Akure, Ondo State, Nigeria

10.21608/mid.2024.292832.1970

Abstract

Background: Wide and unacceptably high mortality rates and sequelae patterns following cerebral malaria (CM) in children have been reported from different regions and periods. Similarly, there is variation in the clinico-laboratory features associated with the outcome. This study aimed to document CM outcomes among children in Nigeria. Methods: Sixty-four children aged 6 – 168 months with CM diagnosed using the WHO criteria were consecutively recruited. Clinico-laboratory data were documented. Neuro-examinations were repeated every four hours until consciousness, then daily until the outcome. The Outcome was classified as favourable (discharged well) or unfavourable (death or neurological sequelae). The predictors of unfavourable outcomes were determined. The values of probability (p) less than 0.05 were considered significant. Results: The predominant clinical presentations were fever (96.9%) and convulsion (92.2%) apart from coma (100.0%). Forty-one children (64.1%) were discharged well, 15 (23.4%) discharged with neurological sequelae and 8 (12.5%) died. Milestones regressions (98.0%) were the most common neurological sequelae at coma recovery, while ataxia (9.4%), aphasia (7.8%) and visual impairment (3.1%) were most common at discharge. Sequelae resolved within two weeks except for one case each of inability to sit, and visual and hearing impairment which resolved within two months. The unfavourable outcomes were significantly associated with focal seizures, breathing difficulty, shock at presentation, profound coma, thrombocytopenia, leucocytosis and hypoglycaemia. However, only thrombocytopaenia (OR=17.181; p = 0.001; 95% CI =3.186-92.648) independently predicted unfavourable outcomes. Conclusion: Closer attention to children admitted for CM with the identified clinico-laboratory features, especially thrombocytopaenia, may improve the outcome.

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