Prevalence of Plasmodium Falciparum Infection in Febrile Children presenting at the University Teaching Hospital; Clinical Presentation and outcome

Abstract

Fever, which is a feature of many childhood illnesses, is the commonest presentation of falciparum malaria, a common and potentially serious disease.To determine the prevalence of Plasmodium falciparum infection in febrile children, it's clinical presentation and outcome, a study was conducted at the University Teaching Hospital between .lanuai-y and April 1999. Four hundred and ninety-seven febrile children between 6 months and five years of age were screened by peripheral blood examination for asexual P. falciparum parasitaemia.The prevalence o[ Plasmodium falciparum parasitaemia in febrile children was found to be 29.4 percent. The first recorded clinical diagnosis of these patients who had malaria parasitaemia on admission was malaria in 60.7 percent of the patients followed by respiratoiy tract infecfion (10.3 percent). The commonest clinical features in decreasing frequency were anorexia, vomiting, cough, convulsions and splenomegaly. Anaemia, which was defined as a haematocrit of less than 33 percent, was a feature in 85.1 percent of the patients. The parasite densities ranged between 0.2 and 53.3 percent (mean 5.33 percent). High parasite density was associated with a clinical diagnosis of malaria on admission (p-value 0.050, odds ratio 2.114).There was, however, no significant association between parasite density and convulsions or parasite density and impaired consciousness. Almost all the patients received anti-malarial treatment, hi addition 54 (37.2 percent) of the patients also received an antibiotic, of which penicillin was the commonest (70.4 percent). Seventeen patients (11.7 percent) received blood transfusions. After three days of follow up 97 (66.9 percent) of the patients were discharged and ten (6.9 percent) died. No association was observed between parasite density and outcome.This study showed that the majority of the children between six months and five years of age presenting with fever at the UTH do not have demonstrable Plasmodium falciparum parasitaemia on admission. The overall outcome of the patients was good. The mortality was 6.9 percent by the third day of admission and it was associated with severe disease as evidenced by the admitting doctors' diagnoses.