Abstract:
Study design: Severe falciparum malaria in children was studied as part of the characterization of
the Kassena-Nankana District Ghana for future malaria vaccine trials. Children aged 6–59 months
with diagnosis suggestive of acute disease were characterized using the standard WHO definition
for severe malaria.
Results: Of the total children screened, 45.2% (868/1921) satisfied the criteria for severe malaria.
Estimated incidence of severe malaria was 3.4% (range: 0.4–8.3%) cases per year. The disease
incidence was seasonal: 560 cases per year, of which 70.4% occurred during the wet season (June-
October). The main manifestations were severe anaemia (36.5%); prolonged or multiple
convulsions (21.6%); respiratory distress (24.4%) and cerebral malaria (5.4%). Others were
hyperpyrexia (11.1%); hyperparasitaemia (18.5%); hyperlactaemia (33.4%); and hypoglycaemia
(3.2%). The frequency of severe anaemia was 39.8% in children of six to 24 months of age and 25.9%
in children of 25–60 months of age. More children (8.7%) in the 25–60 months age group had
cerebral malaria compared with 4.4% in the 6–24 months age group. The overall case fatality ratio
was 3.5%. Cerebral malaria and hyperlactataemia were the significant risk factors associated with
death. Severe anaemia, though a major presentation, was not significantly associated with risk of
death.
Conclusion: Severe malaria is a frequent and seasonal childhood disease in northern Ghana and
maybe an adequate endpoint for future malaria vaccine trials.
