Children with cerebral malaria in New Guinea differ in clinical features and complications from children in Africa.
Features of malaria in New Guinea:
(1) intense year-round transmission
(2) cause of 4-17% of deaths in children < 10 years of age
(3) prevalence of malaria-associated febrile illness and parasite density with age
Features of pediatric cerebral malaria in New Guinea:
(1) fatality rate about 12%
(2) prevalence of residual neurological sequelae at discharge 1.5%
Differences from African children:
(1) lower rate of deep coma
(2) lower rate of hypoglycemia
(3) lower rate of severe complications
(4) lower rate of mortality associated with hypoglycemia on admission
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Indicators for mortality
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Odds Ratio
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malarial anemia (hemoglobin < 5 g/dL or hematocrit < 15% with Plasmodium falciparum parasitemia > 10,000 per µL)
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6.12
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deep coma (Blantyre coma score 0) on admission
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5.12
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prior treatment of some sort
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4.33
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hyperleukocytosis (white blood cell count > 10,000 per µL)
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3.2
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malnutrition (weight for age Z-score > 2 SD below the corresponding NCHS reference median)
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2.98
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history < 3 days
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2.26
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hypoglycemia (blood glucose < 2.2 mmol/L)
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1.77
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where:
• < 2 SD in weight would indicate being below the 5th percentile
Therapeutic recommendations:
(1) correction of shock, hypoglycemia and acidosis
(2) prompt blood transfusion in children with malarial anemia
(3) control of seizures
