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Pediatric malaria in Houston, Texas
I R Rivera-Matos1, J T Atkins, C A Doerr
1Department of Pediatrics, University of Texas Medical School at Houston, 77030, USA.
Insights
Pediatric malaria in Houston primarily affected children of immigrants returning from travel. Targeted education and preventive strategies are crucial for these families during routine well-child care.
Area of Science:
- Pediatric infectious diseases
- Tropical medicine
- Epidemiology
Background:
- Malaria remains a significant global health concern, with imported cases occurring even in non-endemic regions.
- Pediatric malaria presents unique challenges due to the vulnerability of young patients and potential for severe complications.
Purpose of the Study:
- To investigate the epidemiology and clinical characteristics of pediatric malaria cases in Houston, Texas.
- To identify risk factors and trends in pediatric malaria to inform public health interventions.
Main Methods:
- Retrospective review of medical records for pediatric patients (<18 years) diagnosed with malaria.
- Data collection included patient demographics, travel history, malaria species, clinical presentation, and treatment outcomes.
- Analysis focused on identifying common sources of infection and preventive measure adherence.
Main Results:
- Thirty-four pediatric malaria cases were identified between 1988-1993, predominantly in travelers and recent immigrants.
- West Africa was the most frequent travel destination (68%), often the parents' country of origin.
- Fever (97%) and splenomegaly (68%) were common; Plasmodium falciparum was the most prevalent species (56%).
- Anemia was frequent, with 29% experiencing severe anemia, necessitating transfusions in three cases.
- Inadequate or no malaria chemoprophylaxis was reported in 75% of travel-related cases, with poor compliance noted even when prescribed.
Conclusions:
- Pediatric malaria in Houston is strongly associated with international travel, particularly to West Africa, by immigrant families.
- Preventive strategies and education should be enhanced and targeted towards these high-risk populations.
- Routine well-child care provides an opportunity to integrate malaria prevention education for at-risk families.
Abstract:
We retrospectively reviewed the medical records of all infants and children (< 18 years of age) with the discharge diagnosis of malaria who were admitted to the four major pediatric teaching hospitals in Houston, Texas from January 1988 through December 1993. Thirty-four cases of pediatric malaria were identified in three newborns, 22 travelers, and nine recent immigrants. The travel destination was West Africa in 68%, Central America in 14%, India in 14%, and unknown in 4%. The location of the child's and parents' birthplace was available in 77% of the travel-related cases and in all cases the destination of travel was the parents' country of origin. The peak incident of the travel-related cases was late summer and early January corresponding to return from summer or Christmas vacation. Sixteen (75%) of the 22 travel-related cases had received either no prophylaxis (12 of 22) or inadequate (4 of 22) chemoprophylaxis. Half of the patients who were given appropriate chemoprophylaxis admitted to poor compliance. The clinical presentation was usually nonspecific. Fever was the most common symptom (97%) and was paroxysmal in one-third. Splenomegaly was the most common physical finding (68%). The malaria species identified included Plasmodium falciparum (56%), P. vivax (23%), P. malariae (3%), and unidentified (18%). Moderate anemia (hemoglobin level = 7.0-10 g/dL) occurred in 38% and severe anemia (hemoglobin level < 7.0 g/dL) in 29%. Three patients required transfusion. There were no end-organ complications. In summary, pediatric malaria in Houston was primarily seen in immigrants or children of immigrants who returned to their native country. Education and preventive strategies should target these families and should be part of the routine well child care of these children.