The clinical spectrum of severe malaria in children in the east provincial hospital of Bertoua, Cameroon.

Severe malaria claims 1.5 to 2.7 million lives annually most of which are young children in rural areas in sub-Saharan Africa. We retrospectively reviewed the files of 387 patients, admitted and treated for severe malaria according to WHO guidelines, in the Bertoua provincial hospital, a peripheral health center in East Cameroon from 1st October 1998 to 30h October 2000. Our main objective was to study the epidemiological aspects, clinical presentation and outcome. The mean age was 2.7 years (range 2 months - 15 years) among them 214 males and 173 females giving a sex ratio of 1.2. Transmission was observed all year round at variable frequencies with peaks in the rainy seasons. Major symptoms were fever in 202 patients (52.2%), convulsions in 150 (38.8%), prostration in 79 (20.4%) and persistent vomiting in 78 patients (20.2%). Major clinical findings were severe pallor in 196 patients (50.6%) and splenomegaly in 75 patients (19.4%). The average time between onset of symptoms and consultation was 4.4 days (range 1 - 21 days). Blood smears were positive for Plasmodium falciparum in 288 patients (74.4%) and negative in 99 (25.6%). Concerning outcome, recovery was observed in 317 patients (81.9%), interruption of treatment (because of financial constraints) in 58 (15%) and 12 deaths (3.8%). Among the 317 patients who recovered, neurological sequelae were observed in six patients, blindness in four patients and deafness in three patients were the most frequent. We conclude that severe malaria constitutes a major challenge of early diagnosis together with implementation of appropriate treatment especially in rural areas. The use of WHO guidelines in the management of this disease and the recommended preventive measures of vector control have yielded good results in patients managed and followed up in our hospital.