OUTCOME OF CEREBRAL MALARIA IN CHILDREN ADMITTED IN PEDIATRIC WARD CIVIL HOSPITAL SUKKUR

Abstract

Objective: To determine the outcome of cerebral malaria in children admitted in pediatric ward GMC Sukkur.

Methods: A cross-sectional study was conducted in the Department of Pediatric Medicine at GMC Sukkur from 1 st April to 30 th September 2024, using non- probability consecutive sampling. Children aged 2 to 12 years, diagnosed with cerebral malaria, were included, while those with impaired consciousness due to other causes, sickle-cell disease, glucose-6-phosphate dehydrogenase deficiency, trauma, or operated hydrocephalus were excluded. Detailed history, physical examination, and neurological assessments, including Blantyre’s coma scale, were performed. Blood samples for tests such as random blood sugar, complete blood count, blood film for malaria parasites, and serum electrolytes were collected. Cerebrospinal fluid was also analyzed. Blood films were monitored daily for parasite species. All patients received intravenous artesunate as per WHO guidelines and supportive therapies. Outcomes were assessed based on length of hospital stay, neurological deficits at discharge, and mortality. Data recorded in a pre-designed proforma.

Results: A total of 115 children aged 2 to 12 years with cerebral malaria were admitted, with 61 males (53%) and 54 females (47%). The mean age was 6.07 ± 2.73 years, and the average weight and height were 20.20 ± 5.93 kg and 109.98 ± 15.39 cm, respectively. The mortality rate was 32.2%, and 41.7% of survivors (48 patients) were discharged with neurological deficits. The mean length of hospital stay was 5.17 ± 1.52 days. Gender and place of residence showed no significant association (p = 0.750), but a significant link was found between gender and mortality (p = 0.032), with more male deaths. Similarly, 33 male and 15 female patients discharged with neurological deficits (p = 0.004), indicating males were more likely to experience long-term complications. Rural residency  was significantly associated with neurological deficits (p = 0.014), with rural children at higher risk, possibly due to healthcare access or delays. The length of stay was slightly higher for males, but not significantly (p = 0.305). There was no significant difference in family monthly income between males and females (p = 0.246). The findings highlight gender and rural-urban disparities in health outcomes.

Conclusion: This study supports existing literature on the increased vulnerability  of male children to mortality and neurological sequelae in cerebral malaria. It also highlights rural-urban disparities in health outcomes, emphasizing the need for improved healthcare access in rural areas. While parental education and family income showed no significant association, social and healthcare factors remain crucial in addressing pediatric malaria outcomes.