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Clinical Features and Outcome in Children with Severe Plasmodium falciparum Malaria: A Meta-Analysis

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  • Laurens Manning
  • Moses Laman
  • Wendy A Davis
  • Timothy M E Davis

Abstract

Background: Although global malaria mortality is declining, estimates may not reflect better inpatient management of severe malaria (SM) where reported case fatality rates (CFRs) vary from 1–25%. Methods: A meta-analysis of prospective studies of SM was conducted to examine i) whether hypothesized differences between clinical features and outcome in Melanesian compared with African or Asian children really exist, and ii) to explore temporal changes in overall and complication-specific CFRs. The proportions of different SM complications and, overall and complication-specific CFRs were incorporated into the meta-analysis. Adjustments were made for study-level covariates including geographic region, SM definition, artemisinin treatment, median age of participants and time period. Findings: Sixty-five studies were included. Substantial heterogeneity (I2>80%) was demonstrated for most outcomes. SM definition contributed to between-study heterogeneity in proportions of cerebral malaria (CM), metabolic acidosis (MA), severe anemia and overall CFR, whilst geographic region was a significant moderator in for CM and hypoglycemia (HG) rates. Compared with their African counterparts, Melanesian children had lower rates of HG (10% [CI95 7–13%] versus 1% [0–3%], P

Suggested Citation

  • Laurens Manning & Moses Laman & Wendy A Davis & Timothy M E Davis, 2014. "Clinical Features and Outcome in Children with Severe Plasmodium falciparum Malaria: A Meta-Analysis," PLOS ONE, Public Library of Science, vol. 9(2), pages 1-11, February.
    • Handle: RePEc:plo:pone00:0086737
    DOI: 10.1371/journal.pone.0086737
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    References listed on IDEAS

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    1. Viechtbauer, Wolfgang, 2010. "Conducting Meta-Analyses in R with the metafor Package," Journal of Statistical Software, Foundation for Open Access Statistics, vol. 36(i03).
    2. David Moher & Alessandro Liberati & Jennifer Tetzlaff & Douglas G Altman & The PRISMA Group, 2009. "Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-6, July.
    3. Robert W. Snow & Carlos A. Guerra & Abdisalan M. Noor & Hla Y. Myint & Simon I. Hay, 2005. "The global distribution of clinical episodes of Plasmodium falciparum malaria," Nature, Nature, vol. 434(7030), pages 214-217, March.
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