Haematological indices, nutritional assessment and mortality outcome of children presenting with severe malaria to a tertiary hospital in Ghana

Daniel Ansong, Alex Osei-Akoto, Sandra Kwarteng Owusu, Isaac Boakye, Samuel Blay Nguah, David J Sambian, Justice Sylverken, Bernard Arhin
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Background: Severe malaria in children remains the commonest clinical disease in the paediatric emergency units of most hospitals in sub-Saharan Africa. Anaemia and nutritional deficiency are associated with severe malaria. The aim of the study was to describe the haematological indices, nutritional status and mortality among children admitted in a tertiary hospital in Ghana with severe malaria.

Methods: We conducted a prospective cross-sectional study documenting the haematological, nutritional indices and mortality outcomes of children less than five years reporting to the Komfo Anokye Teaching Hospital with severe malaria.

Results: The study recruited four-hundred-and-eight (408) children between April, 2005 and July, 2006. There were 231 males (57%). The median age was 21 months, (1QR: 4-54months). 36 (8.8%) patients had weight-for-age z-score <-3; 101 (24.7%) had z-score ≥-3 to < -2; 130 (31.9%) had z-scores ≥-2 to <-1 and 141 (34.6%) had z-scores ≥-1. The mean haemoglobin level was 6.2g/dl (SD=2.2, 95% CI: 6.0-6.4). The mean haemoglobin levels of children with normal, mild, moderate, and severe malnutrition were 6.5g/dl, 6.0g/dL, 6.0g/dL, and 6.0g/dL, respectively, p=0.15. The overall case fatality rate was 4.9%. Children with malnutrition (weight-for-age z-score ≤-2) had a significantly higher case fatality rate of 8.0% (11/126) compared to those with z-score > -2, 3.3% (RR=1.7, 95%CI: 1.1-2.6, P=0.038).

Conclusion: Malaria in children under five remains a principal cause of morbidity and mortality. The study did not find any association between the haemoglobin levels and the nutritional status. However, Mortality was associated with malnutrition (weight-for-age z-score ≤-2) in this study.


Malnutrition; Severe malaria; Haematological indices; Children; Tertiary Hospital

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