Prostration is associated with death from malaria in sub-Saharan African children, that’s why scientists believe rapid risk stratification at admission is essential to avoid deaths.

A group of research scientists from Tanzania, Gabon, Germany, UK, Austria, Kenya, Ghana, and Mozambique have made the observation in their recent study published in the International Journal of Infectious Diseases.

“Malaria is still one of the main reasons for hospitalization in children living in sub-Saharan Africa… Whereas coma, deep breathing, and, to a lesser degree, severe anaemia are established predictors of malaria-related death, the value of assessing prostration for risk stratification is less certain,” they say.

Over 33,000 hospitalized children data used
In this study, whose results were published on July 4, 2023, the scientists used a retrospective multi-center analysis comprising over 33,000 hospitalized children from four large studies, including two observational studies from the Severe Malaria in African Children network, a randomized controlled treatment study, and the phase-3-clinical RTS, S-malaria vaccine trial, to evaluate known risk factors of mortality and with a specific emphasis on the role of prostration.

“Despite comparable age profiles of the participants, we found significant inter- and intra-study variation in the incidence of fatal malaria as well as in the derived risk ratios associated with the four risk factors: coma, deep breathing, anaemia, and prostration,” comment the scientists. 

“Despite pronounced variations, prostration was significantly associated with an increased risk of mortality and its consideration resulted in improved predictive performance.”

Scientists from 7 partners involved
Scientists who contributed to the study include: Dr. Nahya Salim from Ifakara Health Institute. Other contributors came from the Institute for Tropical Medicine, University Hospital Tübingen, Tübingen, Germany; Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon; Institute for Tropical Medicine, University Hospital Tübingen, Tübingen, Germany; and, Department of Ecology and Conservation, University of Exeter, Exeter, UK.

Others came from the Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany; Translational Infrastructure Epidemiology, German Center for Infection Research (DZIF), Braunschweig, Germany; and Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Austria.

On the list also are: Kenya Medical Research Institute, KEMRI; Kintampo Health Research Center, Kintampo, Ghana; Kwame Nkrumah University of Science and Technology, Agogo, Ghana; and Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique.

>> Full publication: https://doi.org/10.1016/j.ijid.2023.06.022