Abstract

Epidemiological features of severe paediatric malaria in north western Ethiopia

Seboxa, T. Snow, R. W.
East Afr Med J. 1997; 74780-3

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https://doi.org/

Malaria remains a major public health challenge in sub-Saharan Africa, yet our knowledge of the epidemiology of malaria in terms of patterns of mortality and morbidity is limited. To examine the clinical and epidemiological presentation of severe life-threatening malaria in Humera, north western Ethiopia studies were conducted among the childhood population in the community, those presenting to out-patient facilities and those admitted to the district hospital. The overall P. falciparum parasite rate among children aged 0-9 years resident within the area was only 12% confirming the low level of endemicity in this area. P. vivax infections were present in 5% of children. Between July 1993 and June 1994 peak out-patient presentation with Plasmodium falciparum coincided with the rains with over 50% of cases occurring between August and October whilst P. vivax infections were predominant during the hot, dry months. Malaria was an important cause of paediatric admission to the local district hospital with an estimated 4.7% of the at-risk childhood community warranting intensive clinical management each year. Case fatality rates were high and the clinical spectrum of severe disease indicated a preponderance of cerebral malaria cases. In addition, respiratory distress was a feature in 12% of the malaria admissions. The suggestion that the coexistence of Plasmodium falciparum and Plasmodium vivax may serve to reduce the severe clinical consequences of P. falciparum malaria is not supported by these observations. Even though malaria is a major public health problem in sub-Saharan Africa, there exists only a limited understanding of its epidemiology with regard to its patterns of mortality and morbidity. To examine the clinical and epidemiological presentation of severe life-threatening malaria in Humera, northwestern Ethiopia, studies were conducted among children in the community who either presented to outpatient facilities or were admitted to the district hospital. Findings are based upon the analysis of 616 slides taken from randomly selected children aged 0-9 years during October 1995, and 3475 blood smears from febrile children aged 0-9 years examined between July 1993 and June 1994. The overall Plasmodium falciparum parasite infection rate among children aged 0-9 years resident within the area was 12%, a low level of endemicity. P. vivax infections were present in 5% of children. Between July 1993 and June 1994, peak outpatient presentation with P. falciparum coincided with the rains with more than half of the cases occurring during August-October, while P. vivax infections predominated during the hot- dry months. Malaria was an important cause of pediatric admission to the local district hospital, with an estimated 4.7% of the at-risk childhood community needing intensive clinical management annually. Case fatality rates were high and the clinical spectrum of severe disease indicated the existence of a considerable number of cerebral malaria cases. Respiratory distress figured in 12% of malaria admissions. eng