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Protocol for Plasmodium falciparum Infections in Mosquitoes and Infection Phenotype Determination
Published on: July 4, 2007
Clinical algorithm for malaria during low and high transmission seasons
1Department of Paediatrics and Child Health, PO Box 1768, Addis Ababa University, Addis Ababa, Ethiopia.
Insights
Malaria diagnosis in children with fever can be improved using clinical signs like pallor and splenomegaly, especially during high transmission seasons. These indicators enhance diagnostic accuracy when laboratory tests are unavailable.
Area of Science:
- Pediatric infectious diseases
- Tropical medicine
- Diagnostic accuracy studies
Background:
- Malaria remains a significant cause of febrile illness in children in endemic regions.
- Accurate and timely diagnosis is crucial for effective treatment and disease control.
- Clinical signs and symptoms can aid in malaria diagnosis, particularly in resource-limited settings.
Purpose of the Study:
- To determine the prevalence of malaria in children presenting with fever in rural Ethiopia.
- To identify clinical predictors of malaria during both low and high transmission seasons.
- To evaluate the utility of specific clinical signs for malaria diagnosis.
Main Methods:
- A study involving 2490 children aged 2-59 months with fever in rural Ethiopia.
- Data collection included medical history, clinical examination, and laboratory investigations (hemoglobin, blood smear for malaria parasites).
- Statistical analysis related clinical findings to the presence of malaria parasitemia.
Main Results:
- Malaria accounted for 5.9% of febrile cases during the low transmission season (Jan-Apr) and 30.3% during the high transmission season.
- Combinations of fever with previous malaria attack, absence of cough, or pallor improved malaria prediction.
- Fever with previous malaria attack, pallor, or splenomegaly showed high sensitivity and specificity in predicting malaria.
Conclusions:
- Clinical definitions can be improved for malaria diagnosis in low-resource settings lacking microscopy.
- Training healthcare workers to identify pallor and splenomegaly can enhance malaria diagnosis specificity.
- Clinical signs are valuable adjuncts for malaria diagnosis, especially during peak transmission periods.
Objectives:
To assess the proportion of children with febrile disease who suffer from malaria and to identify clinical signs and symptoms that predict malaria during low and high transmission seasons.
Study Design:
2490 children aged 2 to 59 months presenting to a health centre in rural Ethiopia with fever had their history documented and the following investigations: clinical examination, diagnosis, haemoglobin measurement, and a blood smear for malaria parasites. Clinical findings were related to the presence of malaria parasitaemia.
Results:
Malaria contributed to 5.9% of all febrile cases from January to April and to 30.3% during the rest of the year. Prediction of malaria was improved by simple combinations of a few signs and symptoms. Fever with a history of previous malarial attack or absence of cough or a finding of pallor gave a sensitivity of 83% in the high risk season and 75% in the low risk season, with corresponding specificities of 51% and 60%; fever with a previous malaria attack or pallor or splenomegaly had sensitivities of 80% and 69% and specificities of 65% and 81% in high and low risk settings, respectively.
Conclusion:
Better clinical definitions are possible for low malaria settings when microscopic examination cannot be done. Health workers should be trained to detect pallor and splenomegaly because these two signs improve the specificity for malaria.
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