Background: Haemoglobinuria is one of the manifestations of severe malaria and results from severe intravascular
haemolysis. Glucose-6-phosphate dehydrogenase (G6PD) deficiency has been implicated in its aetiology.
Haemoglobinuria may be associated with severe anaemia and, less frequently, acute renal failure.
Methods: A prospective case-control study was carried out to determine the incidence of haemoglobinuria as
confirmed by dipstick urinalysis, microscopy and spectrophotometric measurement, among children with severe
malaria. A total of 251 children presenting at the Children’s Emergency Ward with severe malaria were recruited
over a period of 21 months. The G6PD status and the outcomes of severe malaria in children with and without
haemoglobinuria was studied with respect to renal failure, the recurrence of haemoglobinuria and blood pressure
changes over a three-month follow-up period.
Results: It was found that the incidence of haemoglobinuria among children with severe malaria is 19.1%. Children
<5 years constituted 76.8% of all the study patients. Patients with haemoglobinuria had median age of 52.5
months, which was significantly higher than 35 months in patients without haemoglobinuria (p=0.001). Although,
haemaglobinuria was commoner among boys (54.2%) than girls (45.8%), the difference was not statistically
significant. There were no significant differences between children with and without haemoglobinuria regarding
their nutritional status or parasite densities. Among the clinical features of the study patients, only jaundice was
significantly associated with haemoglobinuria (p=0.0001). Renal failure occurred in three out of 48 children with
haemoglobinuria and in none of the 203 without. There was not recurrence of haemoglobinuria in the follow-up
period. At discharge, blood pressure was elevated in six children (one previously haemoglobinuric), but all returned
to normal within the follow-up period.
Conclusions: Haemoglobinuria was a prominent feature of severe malaria and it was significantly associated with
jaundice at presentation. Haemoglobinuria was commoner in older children than younger children but not related
to sex. G6PD deficiency was not an independent predictor of the occurrence or outcome of haemoglobinuria.
Blood pressure was not affected by haemoglobinuria on admission nor during follow-up.