Factors associated with severe anaemia in Zambian children admitted with Plasmodium falciparum malarial anaemia MODEST MULENGA*, PHIDELIS MALUNGA*, STEVE BENNETT {1 , PHILIP E.THUMA { , CAROLINE SHULMAN { , KATHERINE FIELDING { & BRIAN M.GREENWOOD { *Tropical Diseases Research Centre, Ndola and { Malaria Institute, Macha Mission Hospital, Choma, Zambia, and { London School of Hygiene and Tropical Medicine, UK (Accepted March 2005) Abstract Many cases of severe malarial anaemia are clinically stable, but some can deteriorate rapidly. In a cross- sectional survey of 255 children with clinically stable malarial anaemia, 72 had severe anaemia (PCV (15%) and 183 were moderately anaemic (PCV ,15–21%). Being female, or febrile, or a referral and having low parasitaemia or hepatomegaly were the risk factors for severe anaemia. Introduction In Zambia, severe malarial anaemia (SMA) caused by Plasmodiun falciparum accounts for approximately 10% of all paediatric admis- sions with a case fatality rate of about 8%. 1 Many cases of SMA are clinically stable, and variables in clinical assessment on admission could be helpful in predicting the likelihood of a poor outcome and improving case manage- ment. We conducted an investigation to determine the association of various baseline characteristics with the level of anaemia on admission to hospital in young Zambian children who where clinically stable. Subjects and Methods This study was nested within a randomised, controlled trial of atovaquone–proguanil (AP) vs sulfadoxine–pyrimethamine (SP) in the treatment of children with P. falciparum malarial anaemia (M. Mulenga et al., in preparation). We performed a cross-sectional investigation to evaluate factors associated with SMA at enrolment. Children aged between 6 and 119 months were categorised as having SMA if they had a packed cell volume (PCV) of (15% and as having moderate malarial anaemia (MMA) if they had a PCV between 15% and 21%, and had asexual forms of P. falciparum malaria with a density of 1000–500,000/mL. Children were included if they were clinically stable (could tolerate oral medica- tion, sit or stand unsupported), had P. falciparum and PCV as shown above, a history of fever in the preceding 24 hours, a body weight .5 kg, and parental consent. Exclusion criteria included any of the following: respiratory distress, 2 severe malaria 3 (except severe anaemia and high parasite density), other serious illness, hav- ing received antimalarials other than chlor- oquine in the past 2 weeks, a history of allergy to antifolates. The study was con- ducted between December 2000 and June Reprint requests to: Dr Modest Mulenga, Clinical Sciences Department, Tropical Diseases Research Centre, PO Box 71768, Ndola, Zambia. Fax: z26 02 620737; e-mail: modest.mulenga@lshtm.ac.uk / m.mulenga@fsmail.net 1 Deceased Annals of Tropical Paediatrics (2005) 25, 87–90 # 2005 The Liverpool School of Tropical Medicine DOI: 10.1179/146532805X45674