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Differences in Presentation of Severe Malaria in Urban and Rural Gabon

There are rare comparative studies of the clinical and laboratory features of severe and moderate malaria, including predictors of poor outcome, in rural and urban areas for regions of high malaria transmission. We therefore studied 2,235 children hospitalized for malaria in a rural (Lambaréné) and an urban (Libreville) area in Gabon between January 2001 and December 2002. From children screened, 33% and 48% were hospitalized for malaria in Libreville and Lambaréné, respectively (P < 0.001). Two malaria clinical groups were identified according to the World Health Organization 2000 classification of severe malaria. In both areas, severe malaria was characterized by a high proportion of severe anemia. The case fatality rate was 5-fold lower in Lambaréné than in Libreville (1% versus 5%; P < 0.0001). In both sites, cerebral malaria associated with respiratory distress was the most important predictor of fatal malaria (odds ratio = 10.7, 95% confidence interval = 4.8–23.8 P < 0.0001).

Received March 22, 2006. Accepted for publication December 27, 2006.

Acknowledgments: We thank the children and parents who participated in this study; the laboratory technicians in Libreville and Lambaréné; the staff of the pediatric services in Libreville and Lambaréné; and Drs Bertrand Lell, Michael Ramharter, Elie Mavoungou, and Benjamin Mordmüller for critical comments.

^* Address correspondence to Saadou Issifou, Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, BP 118, Gabon. E-mail: issifou{at}lambarene.mimcom.net

Authors’ addresses: Saadou Issifou, Michel A. Missinou, Pierre Blaise Matsiegui, Sanjeev Krishna, and Peter G. Kremsner, Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, BP 118, Gabon, Telephone: 00241-581099, Fax: 00241-581196, E-mail: issifou{at}lambarene.mimcom.net. Saadou Issifou, Michel A. Missinou, Pierre Blaise Matsiegui, and Peter G. Kremsner, Institute of Tropical Medicine, University of Tübingen, Wilhelmstrasse 27, 72074 Tübingen, Germany. Eric Kendjo, Arnaud Dzeing-Ella, Frédéric A. Dissanami, and Maryvonne Kombila, Département de Parasitologie-Mycologie-Médecine Tropicale, Faculté de Médecine, Université des Sciences de la Santé, BP 4009 Libreville, Gabon. Sanjeev Krishna, Division of Cellular and Molecular Medicine, Centre for Infection, St George’s, University of London, Cranmer Terrace, London SW17 0RE, UK.