Pierre-Fernand Tchokoteu

Initial treatment of severe malaria in children is inadequate - a study from a referral hospital in Cameroon

Background . Severe malaria, caused by Plasmodium falciparum, is potentially fatal, with a case mortality rate of 15 - 20%, despite treatment. Aim . To document epidemiological and clinical features, including initial treatment, of severe malaria in children referred to a general paediatric unit in Cameroon. Methods . A prospective cross-sectional study investigating characteristics of children admitted for severe malaria, confirmed with a positive thick blood smear. Results . A total of 309 (29.2%) children were identified out of 1 060 admissions, of whom 52% were males and 48% females, and mean age 46.3 (1 - 180) months. Most children were aged artesunate + amodiaquine (18%), and artesunate + mefloquine (6%). Only 16% of the mothers said they had used insecticidetreated bed nets (ITNs). Conclusion . In most cases, there is a delay before consultation, with most children initially self-medicated at home. Initial consultations are at primary local health facilities where less effective drugs are prescribed at inadequate dosages. Recommended ACTs were also often prescribed at inadequate dosages. Education in the use of ITNs, home treatment of simple malaria, and appropriate use of ACTs should be promoted.

Seizures in Severe Malaria: Is there Direct Brain Involvement?

Seizures are a frequent manifestation of severe malaria in children especially those less than 5 years of age. Al- though simple febrile seizures occur in young children of the same age group, for a long time it has not been established whether seizures following severe malaria in children of this age group are a consequence of febrile illness or due to cere- bral involvement. The possibility of determining whether these seizures are simply febrile or due to cerebral involvement is important for accuracy of diagnosis and case management; it forms the basis for making prognostic assessments and predicting future neurologic outcome as part of the burden of the disease in sub-Saharan Africa. The purpose of this review is not to pro- duce any new findings. Instead, we aim to present existing evidence for and against the possible involvement of the cen- tral nervous system in seizures accompanying cerebral malaria. This review reveals that controversy still exists and the weight of evidence seems to be on the side of a direct neurologic involvement in patients with seizures from cerebral ma- laria. We conclude with a call for a heightened sense of awareness and the establishment of stringent treatment regimens in patients who present with malaria complicated by seizures.