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Published on: July 4, 2007
Epidemiologic features impacting the presentation of malaria in children in Houston
Gloria E Oramasionwu1, Susan H Wootton, Morven S Edwards
1Section of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA.
Insights
Severe malaria in US children is often linked to vacation travel without proper prophylaxis. Optimizing malaria prevention strategies, especially for travelers, can reduce severe illness in non-endemic areas.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Malaria is diagnosed in US children despite available chemoprophylaxis.
- Features influencing malaria presentation in non-endemic settings are not well-characterized in pediatric populations.
Purpose of the Study:
- To characterize the features and risk factors associated with malaria presentation and severity in children diagnosed in a non-endemic setting.
Main Methods:
- A retrospective chart review of children with confirmed malaria from 1994-2007 at four Houston tertiary hospitals.
- Analysis included patient demographics, travel history, clinical presentation, and treatment outcomes.
Main Results:
- Of 104 children, 21% had severe malaria, with US-residing children accounting for 86% of severe cases.
- Risk factors for severe malaria included vacation travel, female gender, US birth, short travel duration, and delayed presentation.
- Severe malaria cases presented with more vomiting, hepatomegaly, heart murmur, and higher parasitemia.
Conclusions:
- Severe malaria in Houston children was associated with travel to endemic regions without adequate prophylaxis.
- Improving adherence to malaria prophylactic regimens could decrease malaria-related morbidity in non-endemic countries.
Background:
Malaria is diagnosed in children in the United States despite availability of effective chemoprophylaxis. The features impacting the presentation of malaria diagnosed in a nonendemic setting are not well characterized in children.
Methods:
A retrospective chart review was conducted of children with peripheral smear-confirmed malaria diagnosed from 1994 to 2007 at 4 tertiary referral hospitals in Houston, TX.
Results:
Among 104 children with malaria, 43 were recent immigrants and 61 were travelers leaving the United States. Severe malaria accounted for 21 (20%) of episodes. Children residing in the United States accounted for 86% of those with severe malaria. Factors relating to malaria severity included vacation-related travel (P = 0.005), female gender (P = 0.02), birth in the United States (P = 0.043), short travel duration (P = 0.024), and short duration from return to presentation (P = 0.023). Children with severe malaria more often had a history of vomiting (P = 0.048) and presented with hepatomegaly (P = 0.008), heart murmur (P = 0.041), and higher parasitemia (P < 0.001) than those with uncomplicated malaria. Vacation-related travel (aOR 7.6; 95% CI 1.4–61.5), admission hemoglobin (aOR 0.6; 95% CI 0.4–0.8), and admission platelet count (aOR 1.0; 95% CI 1.0-1.0) remained significant risk factors for severity by multivariate analysis. Prophylaxis appropriate to region of travel was documented in only 8 of 47 children leaving the United States.
Conclusions:
Children diagnosed in Houston with severe malaria usually had traveled from the United States to malaria-endemic regions without benefit of appropriate prophylaxis. Malaria-related morbidity in nonendemic countries could potentially be reduced by optimizing adherence to prophylactic regimens.
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