Ruth Namazzi, MBChB
Nominated From: University of Minnesota
Research Site: Uganda
Research Area: Pediatrics
Primary Mentor: Chandy John
Risk of Severe Hemolytic Anemia after Artesunate Treatment for Severe Malaria
This proposed study aims to describe mortality in cerebral malaria using a holistic approach. Previous studies looked either at the clinical picture alone, or the immunological determinants of mortality among children with cerebral malaria. We hope to link clinical, laboratory, immunological and ophthalmoscopic findings in children with CM who died with the aim of better predicting which children are more likely to die.
1. To document the case mortality rate of cerebral malaria among children admitted to Mulago hospital.
2. To describe the clinical, laboratory, immunological and ophthalmological features associated with mortality among children with CM admitted to Mulago Hospital.
3. To determine the effect of HIV infection on mortality among children with CM.
Cerebral malaria (CM), a severe form plasmodium falciparum malaria remains a common cause of mortality among African Children, with mortality rates of 15 -40% being reported. Although major advances have been made in the management, the mortality remains high.
Clinically, it is challenging to predict which patients with CM will have a fatal outcome, and which ones will survive. A Ugandan study among children with malaria demonstrated a higher sensitivity of predicting mortality among children with malaria when using a combination of biomarkers . Other studies have shown that respiratory distress, coma, hypoglycemia, presence of severe anemia, and circulatory failure are associated with mortality among African children with cerebral malaria.
A retrospective study done among Malawian children with cerebral malaria showed that angiopoietin 2 levels were associated with retinopathy, which predicted mortality among these children. HIV co-infection among children with severe malaria has been associated with higher mortality. Since HIV affects cellular immunity; infection with HIV may interfere with development of immunity against malaria, contributing to malaria related mortality. The proposed research study will assess several mechanisms in children who died of cerebral malaria in Uganda.