Tropical doctor
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Your April editorial(1) points out that there is little strong evidence of the effectiveness and impact of health links - or health partnerships, as they are often known - in terms of the processes and particularly the outcomes of health care. We believe this reflects the inherent complexity of the health systems and the consequent challenges for robust measurement. However, health partnerships use a range of evaluation methods that provide valuable, qualitative and descriptive information about change and performance management, which can help demonstrate the effectiveness of health partnerships.
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Acute kidney injury (AKI) is a serious complication of malaria which has a very high mortality rate. A retrospective analysis of medical record data of children treated for malarial AKI in a paediatric intensive care unit (PICU) was performed in order to evaluate the incidence, poor prognostic factors and outcome of AKI with malaria. Eighteen (48.6%) malarial patients had AKI (11 Plasmodium vivax positive, six P. falciparum positive and one mixed infection) with a male-to-female ratio of 1:2. ⋯ Mortality was noted in 33.3% of patients and full recovery was achieved in 50% of patients. Oliguria, shock, central nervous system involvement, jaundice, disseminated intravascular coagulopathy and acute respiratory distress syndrome emerged as bad prognostic factors in simple univariate analysis. Malaria patients with and without AKI differ significantly in terms of shock, ventilator requirement, mortality and length of PICU stay.