Is Albumin Beneficial In Children With Severe Malaria?

Some evidence suggests that lowered blood fluid volume is a factor in determining the outcome in these children. However, very few trials have been done that examine the best way of rehydrating children that are in shock from severe malaria, or what type of fluid should be used.

In this trial, performed by a researcher from Imperial College, London Dr. Kathryn Maitland and her colleagues at The KEMRI-Wellcome Trust Research unit, Kilifi, Kenya, 88 children presenting with severe malaria were given either albumin solution or gelofusine, through an intravenous line. Although the trial didn't show any major differences in the ability of the different types of fluid to resolve shock, the research group found a lower mortality rate in the group receiving albumin.

Dr Kathryn Maitland explains: "The observation that treating very sick children with severe malaria with albumin infusion can reduce the mortality rate by over 80% represent a major breakthrough towards improved treatment of this devastating illness. However, administration of fluid to children critically ill with severe malaria is contrary to prevailing practice and therefore it is absolutely essential that we are certain that the results are true before we advise on any change in practice.

The results of this trial support have gone some way to answering the question of whether this sort of supportive treatment saves lives and we are now seeking funding to set-up a larger trial involving over 1,000 children in Ghana, Gambia and Kenya to confirm these findings."

Nick Day comments in an accompanying perspective: "Given that severe malaria is such an important disease in terms of morbidity and mortality throughout the tropical world, it is astonishing how few clinical trials have addressed its treatment… Akech and colleagues are to be congratulated for pursuing practical clinical answers to how the management of severe malaria in Africa can be improved."

Citation: Akech S, Gwer S, Idro R, Fegan G, Eziefula AC, et al. (2006) Volume expansion with albumin compared to Gelofusine in children with severe malaria: Results of a controlled trial. PLoS Clin Trials 1(5): e21 (http://dx.doi.org/10.1371/journal.pctr.0010021)