Abstract:
Abstract. The symptoms of severe malaria and their contribution to mortality were assessed in 290 children in
northern Ghana. Common symptoms were severe anemia (55%), prostration (33%), respiratory distress (23%), con-
vulsions (20%), and impaired consciousness (19%). Age influenced this pattern. The fatality rate was 11.2%. In mul-
tivariate analysis, circulatory collapse, impaired consciousness, hypoglycemia, and malnutrition independently predicted
death. Children with severe malaria by the current World Health Organization (WHO) classification, but not by the
previous one (1990), showed relatively mild clinical manifestations and a low case fatality rate (3.2%). In hospitalized
children with severe malaria in northern Ghana, severe anemia is the leading manifestation, but itself does not contribute
to mortality. In this region, malnutrition and circulatory collapse were important predictors of fatal malaria. The current
WHO criteria serve well in identifying life-threatening disease, but also include rather mild cases that may complicate
the allocation of immediate care in settings with limited resources.
