Malaria in children in Papua New Guinea

Malaria is a major problem in children in many parts of Papua New Guinea; it has a high mortality and, if observations from other countries are applicable, significant long-term morbidity. Standard treatment regimens are the backbone of management of malaria throughout the country, but these must continue to be reviewed and updated in the face of changing patterns of parasite drug sensitivity. Diagnosis of malaria will for practical purposes remain primarily clinical for the foreseeable future. There is a need for uniform reporting of malaria statistics using the established definitions of uncomplicated, treatment failure and severe malaria, in order to assess incidence and outcome throughout the country, and to compare malaria patterns and outcome in Papua New Guinea with those in other parts of the world. Congenital malaria should always be considered in a febrile or ill neonate. Awareness of the complications of severe malaria, particularly hypoglycaemia, needs to be increased. Methods for the diagnosis and facilities for treatment of hypoglycaemia should be widely available. The characteristics of those children most at risk from hypoglycaemia need elucidation, and the current standard management regimen for severe malaria needs to be assessed for its propensity both to cause and to prevent hypoglycaemia. It would be reasonable to incorporate phenobarbitone prophylaxis of convulsions into the standard management regimen for cerebral malaria.