The relevance of WHO criteria for severe and complicated malaria has been debated for a while, especially as regards children. Recent data led WHO experts to modify the definition of severe malaria. The objective of this study was to evaluate retrospectively the significance of the new definition on severity, lethality and intensive care distribution in children admitted with falciparum malaria (in 1997-99) to Hôpital Principal de Dakar, Senegal. We used the paediatric risk of mortality score (PRISM) to compare the 2 definitions, WHO 2000 and WHO 1990. Finally, we evaluated the impact of the new definition in terms of major therapeutic interventions (MTIs): mechanical ventilation, haemodynamic support, transfusion, haemodialysis, and the use of sedatives. Among 311 patients, the frequencies of severe malaria cases and case-fatality rates thereof were 52% (n = 161) and 17% (n = 28) respectively using the 1990 WHO criteria, and 75% (n = 233) and 12% (n = 28) using the 2000 WHO criteria. Mean PRISM score among severe cases decreased with the new definition (6.5 versus 8.6). Both definitions predicted neurological sequelae and deaths with 100% sensitivity. One or more MTIs were required in severe malaria cases in 86% (n = 139) under the 1990 criteria and 73% (n = 170) under the 2000 criteria. In this area of low and seasonal transmission, the 2000 WHO definition of severe malaria proved broader and less specific, but was easier to apply and retained the high sensitivity of the earlier definition in identifying life-threatening infections.

Adolescent↗

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Severe malaria among children in a low seasonal transmission area, Dakar, Senegal: influence of age on clinical presentation.

The influence of age on the clinical presentation of severe malaria and especially on its 2 most commonly encountered manifestations, cerebral malaria and severe anaemia, has been retrospectively examined in 161 children (< 16 years old) admitted to the paediatric department of Hôpital Principal de Dakar from 1 January 1990 to 29 February 1996. They lived in Dakar and its suburbs, a region of Senegal where the malaria transmission rate is very low. Cases were defined by at least one of the World Health Organization criteria of severe malaria and the presence of Plasmodium falciparum in blood smears. Severe anaemia was present in 73.1%, 52.1% and 26.2% cases of severe malaria among children aged 0-3 years, 4-7 years and 8-15 years, respectively (P < 0.0001). The frequency of cerebral malaria was 11.3%, 28.2% and 60.6%, respectively, in the same age groups (P < 0.0001). Severe anaemia and cerebral malaria were associated in 8.7% of the cases of severe malaria. The fatality rate was significantly lower in cases of severe anaemia without cerebral malaria (3%) than in cases of cerebral malaria without severe anaemia (17.5%; P < 0.02). Among young children, severe anaemia was associated with brief hyperparasitaemia or with prolonged lower parasitaemia. Other things being equal, older children had a lower risk of severe anaemia. The results suggest that the high prevalence of severe anaemia in young children, even in an area of very low endemicity, depends more on age and parasitaemia than on the transmission level.

Adolescent↗

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[Evaluation of the efficacy of mannitol in the treatment of ciguatera in French Polynesia].

Up till now, in the French Polynesia and in New Caledonia, people showing ciguatera intoxication receive a standard treatment: calcium + vitamins B6 and C by intravenous way and in addition, some drugs arriving to cure some symptomatic manifestations. In 1988, an investigation carried out in Majuro, Marshall Islands concluded that intravenous mannitol is efficient in the treatment of serious intoxications with suspecting cerebral oedema. Since, such a treatment has been utilized with success in several endemic areas. Our therapeutic evaluation was arrived to determine whether mannitol's efficiency is higher than the standard treatment in the ciguatera intoxications of mean seriousness. This investigation was carried out on two randomized groups: The first one receiving mannitol (250 cc intravenous at 20% injected in 1 h) the second one receiving the standard treatment (intravenous perfusion glucose serum 250 cc with 1 g of vitamins C, 250 mg of vitamin B6 and 1 g of calcium gluconate injected in 1 h). Seriousness of clinical status was evaluated according to a scale of score from 0 to 50, based on the importance of the clinical manifestations paresthesia, aches, asthenia, cardiovascular and digestive signs. Only patients getting a score at least 20 were included in this investigation. Clinical status of each patient was evaluated before any treatment (initial score) at the end of perfusion and at the 24th hour. Efficiency of each treatment respectively was evaluated according to the differences between these three different scores. CHI 2 and U Mann's and Whitney's tests were utilized for the statistical analysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

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[Hepatic amebiasis in French Polynesia. A study of 25 cases].

The authors report a retrospective study of 25 cases of hepatic amebiasis which were observed from 1988 to 1990 in Tahiti. The symptoms were typical in 20 patients and incomplete in 5 other patients. The ultrasonic examinations showed one (n = 14) or several abscesses (n = 11). The majority were located at the right lobe of the liver (84%). Except in one case where the abscess had a high echo response (it was a pseudo-tumour), the others showed a low echo response or were liquid. The serology (hemagglutination) was always positive but once, at the first examination or afterwards. Recovery was obtained by all patients on an average of 6 days for clinical signs and of three months for ultrasonic features, by administering Metronidazole, combined twice with a drainage (transcutaneous = 1 case, surgical = 1 case). Neither rupture, nor relapse occurred. This series is related to other studies made in South Pacific, Africa and France. It underlines the topicality of amebiasis in French Polynesia, and the interest for the Health Services to carry out a program against this endemy.

Adult↗

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[A dural fistula of the lateral sinus and papillary edema. Apropos of a case].

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Adult↗

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[Neonatal mortality factors at the Dakar General Hospital].

The authors studied 223 new-borns in an African Pediatric Department over a eight month period. The death rate was 47.5 p. cent (106 cases). It was explained by infectious diseases in 53 cases, respiratory distress syndrome in 37 cases, acute foetal distress in 9 cases, jaundice in 6 cases, and malformation syndrome in one case. A birth-weight less than 2.500 g is correlated with a poor prognosis. The authors define target populations in tropical zones to be looked after by aims of prophylactic and curative actions.

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[Population survey of a pediatric department in Dakar].

The survey includes 4.876 children registered in 1983 and 1984. Girls appear to be less frequently admitted than boys (42% and 58% respectively) but they die significantly more often. Lethal rates, all ages merged, are respectively 19 and 15.4%. For both sexes, this rate reaches 47% during the only first month. It is during the hot season that mortality is evidently the highest, because diarrhea, malnutrition and malaria are much more frequent during this season. In 40% of the cases, death occurs during the first 24 hours of hospitalization. A better monitoring during pregnancy and nutrition education would certainly reduce such an over-mortality.

Adolescent↗

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[Morbidity and mortality in a pediatric department in Dakar].

The authors study, for the year 1983, the morbidity and the mortality in a pediatrics department in Dakar. Despite the fact that the patients admitted belong to a privileged group of the senegalese population, the mortality rate is high (17%), mainly during the neonatal period (51.5%), and within the age group of 1 to 23 months (21%). Seasonal influence is obvious. Admissions and deaths are significantly more numerous from june to december. The diseases of concern are still diarrhea, malnutrition and respiratory diseases.

Adolescent↗