Urgent Need for Policy Changes to Cut Mortality from Malaria and Meningitis in Comatose African Children

Recent studies highlight the critical urgency for transforming healthcare approaches to reduce deaths from malaria and meningitis among children in Africa who present with coma. Research published in The Lancet Global Health reveals that nearly 25% of children hospitalized with fever and coma have co-infections, predominantly bacterial, alongside malaria. These coinfections significantly increase mortality risk, especially if antibiotics are not administered promptly.

The studies, encompassing the largest analysis of non-traumatic coma in African pediatric populations over five decades and across 30 countries, underscore that mortality from malaria-related coma has remained at about 20% for decades despite ongoing health interventions such as bed nets, rapid diagnostics, and advanced antimalarial drugs. In Malawi, cerebral malaria has been identified as the leading cause of febrile coma, with over a quarter of cases complicated by bacterial infections detected via advanced molecular diagnostics.

Children with concomitant bacterial meningitis and malaria face higher death rates, emphasizing the need to incorporate immediate antibiotic treatment alongside antimalarials for children presenting with fever and coma, regardless of malaria test results. MRI scans reveal that 90% of these children suffer brain injury, with half experiencing brain swelling, and many with meningitis showing treatable intracranial complications.

Follow-up assessments of survivors show that over half experience long-term disabilities, calling for urgent updates to WHO and national guidelines to include broader use of molecular and radiological diagnostics for early detection. Experts like Dr. Stephen Ray from Oxford and Dr. Charlotte Fuller from Liverpool advocate that earlier and more comprehensive treatment plans, including neurosurgical interventions where necessary, could improve outcomes.

Professor Michael Griffiths emphasizes that the stagnant mortality rates over five decades demand coordinated political, educational, and healthcare investments to improve access to specialized care for affected children. The findings advocate for a paradigm shift in managing pediatric febrile coma in Africa, aiming to save countless young lives and reduce disability.

source: https://medicalxpress.com/news/2025-04-urgent-deaths-malaria-meningitis-comatose.html