Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2017 Aug 3;15(1):147.
doi: 10.1186/s12916-017-0906-5.

Clinical and laboratory predictors of death in African children with features of severe malaria: a systematic review and meta-analysis

Paulina Sypniewska  1   2 , Jose F Duda  3 , Isabella Locatelli  1 , Clotilde Rambaud Althaus  4 , Fabrice Althaus  3 , Blaise Genton  5   6   7
Affiliations
Meta-Analysis

Clinical and laboratory predictors of death in African children with features of severe malaria: a systematic review and meta-analysis

Paulina Sypniewska et al. BMC Med. .

Abstract

Background: The criteria for defining severe malaria have evolved over the last 20 years. We aimed to assess the strength of association of death with features currently characterizing severe malaria through a systematic review and meta-analysis.

Method: Electronic databases (Medline, Embase, Cochrane Database of Systematic Reviews, Thomson Reuters Web of Knowledge) were searched to identify publications including African children with severe malaria. PRISMA guidelines were followed. Selection was based on design (epidemiological, clinical and treatment studies), setting (Africa), participants (children < 15 years old with severe malaria), outcome (survival/death rate), and prognostic indicators (clinical and laboratory features). Quality assessment was performed following the criteria of the 2011 Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). Odds ratios (ORs) were calculated for each study and prognostic indicator, and, when a test was assessed in at least two studies, pooled estimates of ORs were computed using fixed- or random-effects meta-analysis.

Results: A total of 601 articles were identified and screened and 30 publications were retained. Features with the highest pooled ORs were renal failure (5.96, 95% CI 2.93-12.11), coma score (4.83, 95% CI 3.11-7.5), hypoglycemia (4.59, 95% CI 2.68-7.89), shock (4.31, 95% CI 2.15-8.64), and deep breathing (3.8, 95% CI 3.29-4.39). Only half of the criteria had an OR > 2. Features with the lowest pooled ORs were impaired consciousness (0.58, 95% CI 0.25-1.37), severe anemia (0.76, 95% CI 0.5- 1.13), and prostration (1.12, 95% CI 0.45-2.82).

Conclusion: The findings of this meta-analysis show that the strength of association between the criteria defining severe malaria and death is quite variable for each clinical and/or laboratory feature (OR ranging from 0.58 to 5.96). This ranking allowed the identification of features weakly associated with death, such as impaired consciousness and prostration, which could assist to improve case definition, and thus optimize antimalarial treatment.

Keywords: Death; Mortality; Predictors; Severe malaria; Systematic review.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow diagram of the study selection process. Only the first reason for exclusion (as ordered in Appendix) is reported
Fig. 2
Fig. 2
Pooled estimates of odds ratios (with 95% confidence intervals) of each predictor of mortality assessed in at least two studies (without the Severe Malaria in African Children studies) and number of studies by each predictor. The size of each predictor’s box is proportional to the global sample size of studies involved in the corresponding summary odds ratios. *Results calculated by fixed effects
Fig. 3
Fig. 3
Pooled estimates of odds ratios (with 95% confidence intervals) of each predictor of mortality assessed in at least two studies (including the Severe Malaria in African Children studies) and number of studies by each predictor. The size of each predictor’s box is proportional to the global sample size of studies involved in the corresponding summary odds ratios. *Results calculated by fixed effects
See this image and copyright information in PMC

References

    1. World Health Organization Severe malaria. Trop Med Int Health. 2014;19:7. doi: 10.1111/tmi.12313_2. - DOI - PubMed
    1. White NJ, Pukrittayakamee S, Hien TT, et al. Malaria. Lancet. 2014;383:723. doi: 10.1016/S0140-6736(13)60024-0. - DOI - PubMed
    1. World Health Organization Severe falciparum malaria. Trans R Soc Trop Med Hyg. 2000;94(Suppl 1):S1–90. doi: 10.1016/S0035-9203(00)90300-6. - DOI - PubMed
    1. Murray CJL, Ortblad KF, Guinovart C, et al. Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990 and 2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384:2. - PMC - PubMed
    1. Dondorp AM, Fanello CI, Hendriksen IC, et al. Artesunate versus quinine in the treatment of severe falciparaum malaria in African children (AQUAMAT): an open-label, randomized trial. Lancet. 2010;376:1647–57. doi: 10.1016/S0140-6736(10)61924-1. - DOI - PMC - PubMed