Prediction of outcome of severe falciparum malaria in Koraput, Odisha, India: A hospital-based study

BACKGROUND AND OBJECTIVES: Infection with Plasmodium falciparum, caused 627,000 deaths in 2012 in the world. P. falciparum infection causes myriads of clinical manifestations. Exact clinical manifestation resulting in poor prognosis in hyper-endemic epidemiological settings need to be ascertained to save human lives. A hospital-based study was conducted to elucidate the different severe clinical presentations of falciparum malaria and to examine the critical clinical and laboratory parameters on the prognosis of these severe manifestations in a stable hyper-endemic falciparum area in the state of Odisha, India. MATERIALS AND METHODS: Consecutive patients admitted in a tertiary care hospital with severe manifestations of malaria as per WHO criteria and confirmed by parasitological examination were included in the study. A detailed clinical and biochemical parameters were examined. Clinical data were reviewed before being double entered into a computer and analyzed. Statistical analyses were carried out using Epi Info 6.04. Continuous and normal distributed data were compared by two-tailed Student's t-test and proportions compared with χ(2) tests with Yates’ correction or Fisher's exact test. RESULTS AND DISCUSSION: A total of 1320 patients with clinical malaria, diagnosed at outpatients’ department were admitted in the hospital during the 1 year study period of which, 292 (22.1%) were children under 14 years of age. The major clinical categories on admission were hyperpyrexia (70.7%), cerebral malaria (9.4%), malarial anemia (7.7%), algid malaria (1.5%), and malaria associated categories were respiratory infection (2.2%), hepatitis (2.0%), urinary tract infection (1.8%), enteric fever (3.3%), and sickle cell disease (1.2%). The overall case fatality rate (CFR) was 4.3 (57/1320). The CFR in children 12.3 (36/292) was significantly higher when compared to adults, that is, 2.0 (21/1028). The major causes of death were cerebral malaria (45.6%), malaria along with a respiratory infection (19.3%) and anemia (10.5%). Malarial anemia along sickle cell disease accounted for 19.3% of all malaria related deaths. Proportion of mortality due to acute renal failure was higher in adults. Biochemical parameters suggest involvement of multiple organs. The findings suggest that the area can be effectively managed by sustained and continuous preventive and curative efforts.