Severe P. falciparum malaria in Kenyan children: evidence for hypovolaemia

Abstract
Background: The role of volume resuscitation in severe Plasmodium falciparum malaria is controversial. Aim: To examine the role of hypovolaemia in severe childhood malaria. Study design: Retrospective review. Methods: We studied 515 children admitted with severe malaria to a high-dependency unit (HDU) in Kilifi, Kenya. On admission to the HDU, children underwent a further assessment of vital signs and a standard clinical examination. Results: Factors associated with a fatal outcome included deep breathing or acidosis (base excess below –8), hypotension (systolic blood pressure 80 μmol/l), low oxygen saturation (2 = 14.9; p = 0.001). Discussion: Impaired tissue perfusion may play a role in the mortality of severe malaria. Moreover, volume resuscitation, an important life-saving intervention in children with hypovolaemia, should be considered in severe malaria with evidence of impaired tissue perfusion.

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