Dataset Information

Prognostic indicators in adults hospitalized with falciparum malaria in Western Thailand.

ABSTRACT:

Background

Severe malaria remains a major cause of death and morbidity amongst adults in the Asiatic tropics.

Methods

A retrospective analysis of the clinical and laboratory data of 988 adult patients, hospitalized with Plasmodium falciparum malaria and prospectively recruited to malaria studies in western Thailand between 1986 and 2002, was performed to assess the factors associated with a fatal outcome. Different severity scores and classifications for defining severe malaria were compared and, using multiple logistic regression, simple models for predicting mortality developed.

Results

The proportion of patients fulfilling the WHO 2000 definition of severe malaria was 78.1%, and their mortality was 10%. Mortality in patients given parenteral artesunate or artemether (16/317, 5%) was lower than in those given parenteral quinine (59/442, 13%) (P < 0.001). Models using parameter sets based on WHO 1990, 2000 and Adapted AQ criteria plus blood smear parasite-stage assessment gave the best mortality prediction. A malaria prognostic index (MPI), derived from the dataset using five clinical or laboratory variables gave similar prognostic accuracy.

Conclusions

The mortality of severe malaria in adults has fallen and the switch from quinine to artesunate has probably been an important contributor. Prognostic indices based on WHO 2000 definitions, and other simpler indices based on fewer variables, provide clinically useful predictions of outcome in Asian adults with severe malaria.

SUBMITTER: Newton PN

PROVIDER: S-EPMC3711784 | biostudies-literature | 2013 Jul

REPOSITORIES: biostudies-literature

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Publications

Prognostic indicators in adults hospitalized with falciparum malaria in Western Thailand.

Newton Paul N PN Stepniewska Kasia K Dondorp Arjen A Silamut Kamolrat K Chierakul Wirongrong W Krishna Sanjeev S Davis Timothy M E TM Suputtamongkol Yupin Y Angus Brian B Pukrittayakamee Sasithon S Ruangveerayuth Ronnatrai R Hanson Josh J Day Nicholas P J NP White Nicholas J NJ

Malaria journal 20130708

<h4>Background</h4>Severe malaria remains a major cause of death and morbidity amongst adults in the Asiatic tropics.<h4>Methods</h4>A retrospective analysis of the clinical and laboratory data of 988 adult patients, hospitalized with Plasmodium falciparum malaria and prospectively recruited to malaria studies in western Thailand between 1986 and 2002, was performed to assess the factors associated with a fatal outcome. Different severity scores and classifications for defining severe malaria we ...[more]

PMID: 23829311

Similar Datasets

Project description:BackgroundEarly diagnosis and treatment with artesunate-mefloquine combination therapy (MAS) have reduced the transmission of falciparum malaria dramatically and halted the progression of mefloquine resistance in camps for displaced persons along the Thai-Burmese border, an area of low and seasonal transmission of multidrug-resistant Plasmodium falciparum. We extended the same combination drug strategy to all other communities (estimated population 450,000) living in five border districts of Tak province in northwestern Thailand.Methods and findingsExisting health structures were reinforced. Village volunteers were trained to use rapid diagnostic tests and to treat positive cases with MAS. Cases of malaria, hospitalizations, and malaria-related deaths were recorded in the 6 y before, during, and after the Tak Malaria Initiative (TMI) intervention. Cross-sectional surveys were conducted before and during the TMI period. P. falciparum malaria cases fell by 34% (95% confidence interval [CI], 33.5-34.4) and hospitalisations for falciparum malaria fell by 39% (95% CI, 37.0-39.9) during the TMI period, while hospitalisations for P. vivax malaria remained constant. There were 32 deaths attributed to malaria during, and 22 after the TMI, a 51.5% (95% CI, 39.0-63.9) reduction compared to the average of the previous 3 y. Cross-sectional surveys indicated that P. vivax had become the predominant species in Thai villages, but not in populations living on the Myanmar side of the border. In the displaced persons population, where the original deployment took place 7 y before the TMI, the transmission of P. falciparum continued to be suppressed, the incidence of falciparum malaria remained low, and the in vivo efficacy of the 3-d MAS remained high.ConclusionsIn the remote malarious north western border area of Thailand, the early detection of malaria by trained village volunteers, using rapid diagnostic tests and treatment with mefloquine-artesunate was feasible and reduced the morbidity and mortality of multidrug-resistant P. falciparum.

Dataset Information

Prognostic indicators in adults hospitalized with falciparum malaria in Western Thailand.

Background

Methods

Results

Conclusions

Publications

Prognostic indicators in adults hospitalized with falciparum malaria in Western Thailand.

Similar Datasets

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