Longitudinal cohort study of epidemiology of P. falciparum malaria infection in children & different spectrum of complications in an area of intense malaria transmission

Abstract

Objective: Longitudinal cohort study of epidemiology of p. falciparum malaria infection in children & different spectrum of complication in area of intense malaria transmission. Materials & Methods: The study was carried out between Oct 2005 and Sept 2006 in the Department of Paediatrics PMCH Patna. All children (up to 18 yrs of age with fever of short duration visited to hospital either in OPD or indoor without any documented pre-existing systemic illness were included in this study. The cases for present study were selected on random basis amongst the case of malaria as per following protocol. Primary pool patients of all age groups, religion, presented with fever of short duration without any documented pre-existing illness and tested for malaria parasite via PBS (thick & thin smear) and rapid antigen test. Secondary pool cases from primary pool with definite diagnosis of p. falciparum malaria, were further divided into uncomplicated & complicated group according to WHO criteria 2000. Results: The study included 18,700 febrile children who were presented in OPD & indoor in PMCH from Oct 2005 and Sept 2006. All cases selected in the study were diagnosed by microscopy and rapid diagnostic test. Incidence of p. falciparum malaria among febrile children was 84%. Incidence of p. falciparum was 16% of total malaria cases. Incidence of p. falciparum in febrile male children 60% was more than female febrile children 40%. Incidence of p. falciparum in Hindu febrile children (80%) was more than muslim children. Among the p. falciparum positive cases complicated cases were 43.5% and uncomplicated cases were 56.67%. The commonest age group of p. falciparum was in between 5-10 yrs (40%), followed by in <5 yrs (29%), in 10-15 yrs (25.33%) and >15 yrs (5.67%). Cerebral anemia was commonest complication (29.23%) of p. falciparum infection followed by jaundice (29.2%), hypoglycaemia (29.2%), and severe anemia (24.6%). MODS (21.33%), ARDS (3.07%), shock (3.07%), DIC (1.5%), acidosis (4.61%), ARF (6.15%) were uncommon complications. Conclusion: During this study, it was observed that p. falciparum malaria account for good number cases among febrile children. It should be screened for in any child present with fever along with hepatomegaly and or spleenomegaly to diagnose early. Once diagnose p. Falciparum, should be treated & managed urgently and appropriately to prevent dreaded complications, and so that mortality and morbidity due to complicated malaria could prevented or decreased.