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
Microbes and Infectious Diseases
Articles in Press, Accepted Manuscript, Available Online from 15 June 2024
Document Type: Original Article
DOI: 10.21608/mid.2024.292832.1970
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Authors
Tolulope Jegede¹; Saheed Oseni²; Akintunde Okeniyi²; Bankole Kuti³; Samuel Adegoke²; Olakunle Salau¹; Abel Alonge¹; Ifedayo Fasoranti¹; Olaseinde bello⁴; ABIODUN J KAREEM ¹; Temitope Jegede⁵; Oladele Olatunya⁶; Oyeku Oyelami²; Korede Oluwatuyi¹; Stanley Obasohan¹; Ikechukwu Abazu¹; Emmanuel Babalola¹; Patricia Eniowo⁷
¹Department of Paediatrics, Federal Medical Centre, Owo, Ondo state, Nigeria
²Department of Paediatrics and Child Health, Obafemi Awolowo University, Ile-Ife, Osun state, Nigeria
³Department of Paediatrics and Child Health Obafemi Awolowo University, Ile Ife
⁴Department of Paediatrics, University of Medical Sciences Teaching Hospital Akure, Ondo state, Nigeria
⁵Department of Psychiatry, Federal Neuropsychiatry Hospital, Uselu, Benin City, Edo state, Nigeria
⁶Department of Paediatrics, Ekiti State University, Ado-Ekiti, Ekiti-State, Nigeria
⁷Department of Paediatrics, Mother and Child Hospital, Akure, Ondo State, Nigeria
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.
Keywords
Cerebral malaria; Nigeria; Outcomes; Predictors; Thrombocytopaenia


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