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Predicting mortality for paediatric inpatients where malaria is uncommon.

Publication ,  Journal Article
Clifton, DC; Ramadhani, HO; Msuya, LJ; Njau, BN; Kinabo, GD; Buchanan, AM; Crump, JA
Published in: Arch Dis Child
October 2012

OBJECTIVE: As the proportion of children living low malaria transmission areas in sub-Saharan Africa increases, approaches for identifying non-malarial severe illness need to be evaluated to improve child outcomes. DESIGN: As a prospective cohort study, we identified febrile paediatric inpatients, recorded data using Integrated Management of Childhood Illness (IMCI) criteria, and collected diagnostic specimens. SETTING: Tertiary referral centre, northern Tanzania. RESULTS: Of 466 participants with known outcome, median age was 1.4 years (range 2 months-13.0 years), 200 (42.9%) were female, 11 (2.4%) had malaria and 34 (7.3%) died. Inpatient death was associated with: Capillary refill >3 s (OR 9.0, 95% CI 3.0 to 26.7), inability to breastfeed or drink (OR 8.9, 95% CI 4.0 to 19.6), stiff neck (OR 7.0, 95% CI 2.8 to 17.6), lethargy (OR 5.2, 95% CI 2.5 to 10.6), skin pinch >2 s (OR 4.8, 95% CI 1.9 to 12.3), respiratory difficulty (OR 4.0, 95% CI 1.9 to 8.2), generalised lymphadenopathy (OR 3.6, 95% CI 1.6 to 8.3) and oral candidiasis (OR 3.4, 95% CI 1.4 to 8.3). BCS <5 (OR 27.2, p<0.001) and severe wasting (OR 6.9, p<0.001) were independently associated with inpatient death. CONCLUSIONS: In a low malaria transmission setting, IMCI criteria performed well for predicting inpatient death from non-malarial illness. Laboratory results were not as useful in predicting death, underscoring the importance of clinical examination in assessing prognosis. Healthcare workers should consider local malaria epidemiology as malaria over-diagnosis in children may delay potentially life-saving interventions in areas where malaria is uncommon.

Duke Scholars

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Published In

Arch Dis Child

DOI

EISSN

1468-2044

Publication Date

October 2012

Volume

97

Issue

10

Start / End Page

889 / 894

Location

England

Related Subject Headings

  • Tertiary Care Centers
  • Tanzania
  • Severity of Illness Index
  • Risk Factors
  • Prospective Studies
  • Predictive Value of Tests
  • Pediatrics
  • Male
  • Malaria, Falciparum
  • Inpatients
 

Citation

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ICMJE
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Clifton, D. C., Ramadhani, H. O., Msuya, L. J., Njau, B. N., Kinabo, G. D., Buchanan, A. M., & Crump, J. A. (2012). Predicting mortality for paediatric inpatients where malaria is uncommon. Arch Dis Child, 97(10), 889–894. https://doi.org/10.1136/archdischild-2012-301812
Clifton, Dana C., Habib O. Ramadhani, Levina J. Msuya, Boniface N. Njau, Grace D. Kinabo, Ann M. Buchanan, and John A. Crump. “Predicting mortality for paediatric inpatients where malaria is uncommon.Arch Dis Child 97, no. 10 (October 2012): 889–94. https://doi.org/10.1136/archdischild-2012-301812.
Clifton DC, Ramadhani HO, Msuya LJ, Njau BN, Kinabo GD, Buchanan AM, et al. Predicting mortality for paediatric inpatients where malaria is uncommon. Arch Dis Child. 2012 Oct;97(10):889–94.
Clifton, Dana C., et al. “Predicting mortality for paediatric inpatients where malaria is uncommon.Arch Dis Child, vol. 97, no. 10, Oct. 2012, pp. 889–94. Pubmed, doi:10.1136/archdischild-2012-301812.
Clifton DC, Ramadhani HO, Msuya LJ, Njau BN, Kinabo GD, Buchanan AM, Crump JA. Predicting mortality for paediatric inpatients where malaria is uncommon. Arch Dis Child. 2012 Oct;97(10):889–894.

Published In

Arch Dis Child

DOI

EISSN

1468-2044

Publication Date

October 2012

Volume

97

Issue

10

Start / End Page

889 / 894

Location

England

Related Subject Headings

  • Tertiary Care Centers
  • Tanzania
  • Severity of Illness Index
  • Risk Factors
  • Prospective Studies
  • Predictive Value of Tests
  • Pediatrics
  • Male
  • Malaria, Falciparum
  • Inpatients