Blood Product Saves Children with Malaria

Malaria claims the lives of at least one million children in Africa every year and most of these die as a result of complications brought on by the mosquito-borne disease before treatment can take begin to take effect.

In an attempt to buy time doctors try to control the complications by introducing fluids as quickly as possible. But determining the best way of doing this has been hampered by a lack of clinical trials.

Now, a study, carried out over 18 months at Kilifi General Hospital in Kenya, by Dr Kathryn Maitland and colleagues, Professor Mike Levin and Dr Charles Newton, has shown the apparent benefits of albumin treatment.

Of 117 children, aged from six months to four years, who were admitted in a critical condition suffering from severe malaria and shock, 61 were given saline solution and 56 received albumin, delivered rapidly through an intravenous line.

Eleven of those given saline died compared to just two who received albumin. Results of the trial, which were funded by the Wellcome Trust biomedical research charity, Imperial College London, and meningitis charity, COSMIC, are published in today’s (Feb 15th 2005) edition of Clinical Infectious Diseases.*

Dr.Maitland, who works at the Wellcome Trust/KEMRI** research unit at Kilifi, said : “ In many cases children with severe malaria die within hours of being admitted to hospital due to life-threatening complications. Often we don’t get the chance to treat the actual disease.

“If we can buy time by correcting volume deficits and improving circulation it gives us a fighting chance to treat the malaria as well. This study has shown that albumin appears to save the lives of children who are in a coma when they arrive at hospital. It’s an exciting development but I must stress the results need to be confirmed by a larger trial. We want to ensure this is not just a quirk.

“ In emergency and critical care medicine there has been much debate over whether albumin is more effective than saline in the treatment of shock.Albumin is hugely expensive – around £100 a litre compared to two pounds for the same amount of saline- and currently unavailable in Africa.

“Nevertheless, albumin was used as a targeted therapy in this clinical trial to investigate whether correction of fluid deficits could be more safely achieved without risking damage to the brain, one of the recognised complications of fluid resuscitation. The results of this trial support the benefit of albumin over saline and has gone some way to answering the question of whether this sort of supportive treatment saves lives.”

Dr Maitland is now seeking funding to set-up a larger trial involving over 1,000 children in Ghana, Gambia and Kenya. If the small study results are confirmed it could have a dramatic impact on the treatment of malaria, which kills up to 2.7m people a year, many of them children under five-years-old.