Clinical and laboratory predictors of death in African children with features of severe malaria: a systematic review and meta-analysis

Abstract Background The criteria for defining severe malaria have evolved over the last 20 years. We aimed to assess the strength of association of death with features currently characterizing severe malaria through a systematic review and meta-analysis. Method Electronic databases (Medline, Embase, Cochrane Database of Systematic Reviews, Thomson Reuters Web of Knowledge) were searched to identify publications including African children with severe malaria. PRISMA guidelines were followed. Selection was based on design (epidemiological, clinical and treatment studies), setting (Africa), participants (children 2. Features with the lowest pooled ORs were impaired consciousness (0.58, 95% CI 0.25–1.37), severe anemia (0.76, 95% CI 0.5– 1.13), and prostration (1.12, 95% CI 0.45–2.82). Conclusion The findings of this meta-analysis show that the strength of association between the criteria defining severe malaria and death is quite variable for each clinical and/or laboratory feature (OR ranging from 0.58 to 5.96). This ranking allowed the identification of features weakly associated with death, such as impaired consciousness and prostration, which could assist to improve case definition, and thus optimize antimalarial treatment