Clinical and Laboratory Findings in Children Presenting with Cerebral Malaria to Five Referral Hospitals in Greater Accra, Ghana 2012-2016

Abstract

Introduction Cerebral malaria is the severest form of malaria. About a fifth (20%) of children who get malaria develop cerebral malaria. An improved understanding of the clinical manifestation and mediators of cerebral malaria can form the basis of improved therapeutic options. This study aimed to describe the demographic and clinical profile of children presenting with cerebral malaria to five referral facilities in the Greater Accra Region of Ghana from 2012-2016. Methods Data was obtained from children presenting with cerebral malaria at five referral hospitals in the Greater Accra Region. Cerebral malaria was diagnosed on the basis of changes in mental status and or coma accompanied by malaria parasitaemia. The analysis aimed to describe the clinical presentations and explored how degree of parasitaemia was related to clinical presentation. The study was nested within a large study that is investigating the immunological markers of severe malaria. Results Eight-three (65% males) children with cerebral malaria were enrolled. Their mean age was 5.5 (standard deviation-SD=2.8) years. While most (62.7%) children presented with temperatures above 37.50C, all (100%) presented with a Blantyre Coma Score of less than 3. Convulsion was present in 53% of cases. About half (49%) of patients who presented unconscious only regained consciousness 24 to 48 hours after arrival. The mean levels of parasitaemia and haemoglobin level were 36113.3(SD=77747.4)/uL and 8.9 (SD=1.8) g/dl respectively. Thrombocytopenia (54.2%) and moderate anaemia (32.5%) were the major laboratory findings. Bacterial coinfection was present in only 2.4% of cases. The case fatality rate was 7.23%. Of all the explored clinical parameters at time of presentation, only duration of fever was significantly associated with degree of parasitaemia (P-value=0.02). Conclusion There is a male preponderance among cases presenting with cerebral malaria. The majority of cases present acute conditions and require emergency care. The lack of association between degree of parasitaemia and features of clinical presentation make a case for the continued investigation of other mediators of cerebral malaria.