A study of presentation and complications among the malaria death cases from three municipal corporation hospitals and civil hospital of Ahmedabad during the year 2007

Context: Characterization of severe malaria cases on arrival to hospital may lead to early recognition and improved management. Understanding of symptoms, signs, and laboratory parameters which are associated with high case-fatality rate (CFR) can help in appropriate and early management of cases. Aims: To study the profile, symptoms, signs, and laboratory parameters of malaria death cases. Materials and Methods: Information about deaths due to malaria, as reported to malaria Department of Ahmedabad Municipal Corporation by three municipal corporation hospitals and civil hospital Ahmedabad between January 2007 and December 2007, was used to locate details of those deaths in respective hospitals. Indoor case papers and death reports of those cases were obtained from Medical Record Section of respective hospitals and were analyzed by using appropriate statistical software. Results: A total of 57 malaria deaths occurred in the abovementioned four hospitals. Overall CFR was 3.03% for indoor malaria cases. Complete information could be obtained for about 42 cases. Mean age of cases was 36.50 years. There were 45.23% of patients falling in the age group >=40 years. There were 57.1% males and 42.9% females. Fifty-five cases were positive for Plasmodium falciparum, one case for Plasmodium vivax, and one case was having mixed infection. Average duration of hospital stay was 2.87 days and average total duration of illness was 6.82 days. The most common presenting symptom was intermittent fever with vomiting and altered sensorium in 38.88% of cases. Acute renal failure was the most common complication seen in 45.2% of the cases. Paired t-test was applied on the investigations carried out on the day of admission and those carried out on the day or before a day of death and found significant for the levels of hemoglobin, blood urea, and serum bilirubin. Conclusions: Malaria still remains one of the important causes of admission and mortality. In view of changes in antimalarial drug policy artemisinin combination therapy and accurate, rapid diagnostic tools are necessary to target treatment to people in need.