The research papers, published in April 2025 in The Lancet Global Health, are together the largest analysis of febrile non-traumatic coma in children on the African continent to date.
Fever and coma is a common hospital presentation in African children, most often caused by malaria of the brain (cerebral malaria), followed by bacterial meningitis. However, these diseases have very similar symptoms and the limited diagnostic testing available makes them difficult to diagnose and treat.
The first study: The aetiology, mortality and disability of non-traumatic coma in African children: A systematic review and meta-analysis, reviewed all previous studies for non-traumatic coma in African children, and found that the death rate due to malaria infection has remained unchanged for nearly fifty years, with nearly one in every five children dying. This is despite decades of research and health interventions like bed-nets, rapid diagnostics for malaria and improved antimalarial drugs.
The second study, Aetiology, neuroradiological features, long-term neurosequelae and risk factors for mortality of febrile coma in Malawian children: A prospective cohort study, was undertaken in Malawi, and found that cerebral malaria is the leading cause of febrile coma and that over a quarter of cases were complicated by co-infections. These infections were mostly bacterial, and detected through the use of molecular tools like pathogen-specific PCR tests on blood and spinal fluid, which are significantly more accurate than routine laboratory methods. Children with malaria and a bacterial meningitis co-infection were more likely to die, compared to those with malaria alone, and the risk of death was even greater if co-infected children did not receive antibiotics.
Crucially, the findings confirm a need to urgently re-consider frontline management for children who present with fever and coma, and indicate the critical need for immediate antibiotics (alongside antimalarials), irrespective of malaria diagnosis.
Read the full story on the Department of Paediatrics website.