Malaria Cases In Children Research Articles

The monthly trends of malaria cases in children under 5 years of age in Guinea: comparative analysis between a seasonal malaria chemoprevention (SMC) and a non-SMC health district

BackgroundThe Republic of Guinea, where malaria represents the leading cause of morbidity and mortality among children, the seasonal malaria chemoprevention (SMC) is deployed only in areas with very seasonal modes of transmission. It should target children at the highest risk of serious illness. The objective of the study was to prevent uncomplicated and serious cases of malaria in the target population. This study aimed to analyse the monthly trends in malaria-related morbidity among children under the age of 5 in Guinea.MethodsThis was a quasi-experimental study with routine data from the National Health Information System (SNIS). The two districts Mamou (the SMC intervention site) and Kindia (the control site) were selected to compare the monthly trends in malaria cases among children under the age of 5, from July to October, covering the years from 2015 to 2020. The statistical analysis used interrupted time series to estimate the effects of the SMC.ResultsThe SMC programme contributed to a significant average reduction in the number of malaria cases of 225 cases per month in the intervention district (95% CI − 362 to − 88; p = 0.002), compared to the control district. However, the study also revealed that the effect of SMC varied between cycles, presenting different monthly malaria cases.ConclusionThe SMC contributed to a significant reduction in malaria cases among children under the age of 5 in the health district of Mamou from 2018 to 2020. However, this reduction varied by monthly SMC cycle. This study suggests extending the SMC in other areas with high perennial seasonal transmission respecting the World Health Organization SMC eligibility criteria, as a strategy in the dynamic of reducing malaria cases in children under the age of 5 in Guinea.

Imported Malaria in Children: A Study Over an 11-Year Period in Brussels.

Malaria is a major global public health concern in endemic countries and imported childhood malaria is increasing in malaria non-endemic countries. This was a retrospective case review of all laboratory-confirmed malaria cases in children 0-16 years admitted between 2009 and 2019 in 2 large university teaching Hospitals in Brussels. A total of 160 children with a median age of 6.8 years (range 5-191 months) were included. We identified 109 (68%) children living in Belgium who had acquired malaria during their visit to malaria-endemic countries to visiting friends and relatives (VFRs), 49 children (31%) visitors or newly installed migrants, and 2 Belgian tourists. Peak seasonal incidence occurred between August and September. Plasmodium falciparum was responsible for 89% of all malaria cases. Almost 80% of children living in Belgium visited a travel clinic for advice, but only one-third reported having taken the prophylaxis schedule according to the recommendations. Based on WHO criteria, 31 children (19.3%) developed severe malaria; most of the patients with severe malaria were VFR travelers and were significantly younger, had higher leukocytosis, had more thrombocytopenia, higher CRP, and lower natremia compared with patients with an uncomplicated course. All children recovered fully. Malaria is a significant cause of morbidity among returning travelers and newly arrived immigrants to Belgium. Most of the children had an uncomplicated disease course. Physicians should educate families about traveling to malaria-endemic areas to correct malaria preventive measures and prophylaxis.

Confirmed Malaria Cases in Children under Five Years: The Influence of Suspected Cases, Tested Cases, and Climatic Conditions

Tropical and potentially fatal malaria is brought on by the parasite Plasmodium spp which spreads through infected female anopheles mosquitoes within the human populations. In Ghana, malaria is endemic and perennial, with distinct seasonal fluctuations in the northern part. Children aged below five years are among the population most vulnerable to malaria in Ghana. This study’s goal is to establish how suspected malaria cases, tested malaria cases, and climatic conditions impact confirmed malaria cases in children under five years in the Sunyani Municipality, Bono Region, Ghana. The dependent variable, monthly number of confirmed cases of malaria in children under five years, was modelled with the independent variables, monthly number of tested cases of malaria in children under five years, mean monthly relative humidity, mean monthly rainfall, and mean monthly temperature, in the Sunyani Municipality. We employed multiple linear regression after data transformation, exploratory data analysis, and correlation analysis. Results show that tested malaria cases and climatic factors significantly influence confirmed malaria cases in children under 5 years. About 41.8% of variations in confirmed malaria cases among children under 5 years is attributed to climatic factors and the number of tested cases. Moreover, results show that increase in tested cases and rainfall leads to more confirmed malaria cases among children under 5 years, while increase in temperature reduces malaria infections. To reduce the incidence of malaria in children under five years, the government and its stakeholders should encourage parent to let their children sleep in treated mosquito nets, distil stagnant waters during raining seasons, spray bushes with antimosquito insecticides, and destroy all breeding grounds of mosquitoes at all times. We proposed that all malaria cases should be laboratory tested and properly confirmed.

FREQUENCY OF THROMBOCYTOPENIA IN CONFIRMED CASES OF MALARIA IN CHILDREN

Objective: To determine the frequency of thrombocytopenia in confirmed cases of malaria in children
 Methods: This cross sectional study was conducted in Pediatric Department of Mayo Hospital Lahore from January to June 2018. A total of 80 Children between two years- 12 years of age, of both the genders with confirmed malaria were included by non-probability consecutive sampling. A blood sample was taken within 48 hours of admission and their complete blood count was reviewed for the presence of thrombocytopenia after malaria was confirmed on positive peripheral smear. Thrombocytopenia was defined as platelet count of less than 150,000/µl of blood. All collected data was entered and analyzed in SPSS version 22. Data was stratified for age and gender to address effect modifiers. Presence of thrombocytopenia was presented as frequencies and percentages.
 Results: Out of total 80 patients with positive malarial parasite (MP) slide, 65 cases (81.25%)were of Plasmodium Vivax,12(15%) were of Plasmodium Falciparum while 3 cases (3.75%) were of Mixed infection. 44 patients( 55%)were having low platelet count (less than 150,000/µl) while 36 patients(45%) had no thrombocytopenia. Out of 44 patients with thrombocytopenia, 16 patients (20%) had mild thrombocytopenia, 21 patients (26.3%) had moderate thrombocytopenia while 7 patients (8.8%) had severe thrombocytopenia. There was no significant association of thrombocytopenia with age, gender or duration of malaria. 
 Conclusions: Frequency of thrombocytopenia in confirmed cases of malaria in children is 55% hence; presence of thrombocytopenia in febrile patients can raise the possibility of malaria leading to early diagnosis and management.

Perennial malaria chemoprevention with and without malaria vaccination to reduce malaria burden in young children: a modelling analysis

BackgroundA recent WHO recommendation for perennial malaria chemoprevention (PMC) encourages countries to adapt dose timing and number to local conditions. However, knowledge gaps on the epidemiological impact of PMC and possible combination with the malaria vaccine RTS,S hinder informed policy decisions in countries where malaria burden in young children remains high.MethodsThe EMOD malaria model was used to predict the impact of PMC with and without RTS,S on clinical and severe malaria cases in children under the age of two years (U2). PMC and RTS,S effect sizes were fit to trial data. PMC was simulated with three to seven doses (PMC-3-7) before the age of eighteen months and RTS,S with three doses, shown to be effective at nine months. Simulations were run for transmission intensities of one to 128 infectious bites per person per year, corresponding to incidences of < 1 to 5500 cases per 1000 population U2. Intervention coverage was either set to 80% or based on 2018 household survey data for Southern Nigeria as a sample use case. The protective efficacy (PE) for clinical and severe cases in children U2 was calculated in comparison to no PMC and no RTS,S.ResultsThe projected impact of PMC or RTS,S was greater at moderate to high transmission than at low or very high transmission. Across the simulated transmission levels, PE estimates of PMC-3 at 80% coverage ranged from 5.7 to 8.8% for clinical, and from 6.1 to 13.6% for severe malaria (PE of RTS,S 10–32% and 24.6–27.5% for clinical and severe malaria, respectively. In children U2, PMC with seven doses nearly averted as many cases as RTS,S, while the combination of both was more impactful than either intervention alone. When operational coverage, as seen in Southern Nigeria, increased to a hypothetical target of 80%, cases were reduced beyond the relative increase in coverage.ConclusionsPMC can substantially reduce clinical and severe cases in the first two years of life in areas with high malaria burden and perennial transmission. A better understanding of the malaria risk profile by age in early childhood and on feasible coverage by age, is needed for selecting an appropriate PMC schedule in a given setting.

Asymptomatic Malaria Infections in the Time of COVID-19 Pandemic: Experience from the Central African Republic.

According to the latest World Health Organization malaria report, 95% of 241 million global malaria cases and 96% of 627,000 malaria deaths that were recorded in 2020 occurred in Africa. Compared to 2019, 14 million more cases and 69,000 more malaria deaths were recorded, mainly because of disruptions to medical services during the COVID-19 pandemic. The aim of this study was to assess the prevalence of asymptomatic malaria cases in children and adults living in the Dzanga Sangha region in the Central African Republic (CAR) during the COVID-19 pandemic. Rapid immunochromatographic assays for the qualitative detection of Plasmodium species (P. falciparum, P. vivax, P. ovale/P. malariae) circulating in whole blood samples were used. A screening was performed in the group of 515 patients, 162 seemingly healthy children (aged 1–15) and 353 adults, all inhabiting the villages in the Dzanga Sangha region (southwest CAR) between August and September 2021. As much as 51.2% of asymptomatic children and 12.2% of adults had a positive result in malaria rapid diagnostic tests (mRDTs). Our findings demonstrated a very high prevalence of asymptomatic malaria infections in the child population. Limited access to diagnostics, treatment and prevention of malaria during the global COVID-19 pandemic and less medical assistance from developed countries may be one of the factors contributing to the increase in the prevalence of disease in Africa.

Seeking research questions from implementers: considerations for leveraging ground actors research needs in the fight against malaria in West Africa

BackgroundTo strengthen the fight against malaria, it is imperative to identify weaknesses and possible solutions in order to improve programmes implementation. This study reports experiences gained from collaboration between decision-makers and researchers from a World Bank project (Malaria and Neglected Tropical Diseases in the Sahel, SM/NTD). The objectives of this paper were to identify bottlenecks in malaria programme implementation as well as related research questions they bring up.MethodsQuestionnaire addressed to National Malaria Control Programme managers and prioritization workshops were used as a medium to identify research questions. The bottlenecks in malaria programme implementation were identified in seven thematic areas namely governance, human resources, drugs, service provision, use of prevention methods, monitoring and evaluation (M and E), and public support or buy-in. The first five priority questions were: (1) compliance with drug doses on the second and third days during the seasonal chemoprevention (SMC) campaigns, (2) the contribution of community-based distributors to the management of severe cases of malaria in children under 5 years, (3) the SMC efficacy, (4) artemisinin-based combination therapy (ACT) tolerance and efficacy according to existing guidelines, and (5) the quality of malaria control at all levels of the health system.Results and conclusionThis work showed the effectiveness of collaboration between implementers, programmes managers, and researchers in identifying research questions. The responses to these identified research questions of this study may contribute to improving the implementation of malaria control programmes across African countries.

MALAR A IN CHILDREN IN THE ASTRAKHAN REGION: THE STATE OF THE PROBLEM

The purpose of the study. To study and analyze the epidemiological situation of malaria in children in the Astrakhan region for 1996-2020. Materials and methods. Epidemiological maps of individuals malaria cases (n'164 epidcards), reporting forms of FBHI «Center for Hygiene and Epidemiology in Astrakhan Region» (form 2) for 1998-2020 (25 documents), the journal of the population survey on malaria (18 journals), as well as microreparates with malaria «fat» and «thin ointment» (82 drugs). Results of the study. The largest number of cases of malaria were reported in 1999 and 2000. In these years, cases of three-day malaria were recorded, except in 2000, when in 1 case four-day malaria was recorded. In the previous 2008 and other years, only three-day malaria cases were reported. Most often, malaria was registered in children aged 2, 13 and 15 years. Thus, in children aged 2 and 15 years, malaria was registered in 12,2 % (5 people each), and at the age of 13 years - in 17,1 % (7 people). In children of other ages, cases of malaria were recorded in isolated cases. In most cases, imported cases of malaria were recorded -90,2 % (37 people). The import of malaria to the Astrakhan region was mainly carried out from Azerbaijan - 86,5 % (32 people), also from Tajikistan - 8,1 % (3 people), Armenia and Uzbekistan - 2,7 % each (1 person). In all cases, only three-day malaria was recorded. The clinical diagnosis of «Malaria» was made on the basis of a laboratory blood test - the preparations «thick» drop and «thin» smear and confirmed by employees of the Laboratory of Bacteriological and parasitological studies of the Federal Budgetary Healthcare Institution «Center for Hygiene and Epidemiology in the Astrakhan region». Conclusions. In recent years, the Astrakhan region has seen a decrease in the number of cases of imported malaria not only among children, but also among the adult population. Malaria was imported to the Astrakhan region mainly from Azerbaijan. Cases of malaria in children were reported most often from April to July, when the optimal temperature for malaria transmission is maintained in malaria-endemic countries. Detection of a case of malaria in a child in March 2008 indicates a long incubation of P. vivax (+24-25 °C for 10-11 days) in the fall of 2007.

Quality of Management of Severe Malaria Cases in Children under Five: A Case of Four Health Facilities in the Littoral Department in Benin

Background: Benin republic is a sub-Saharan African country endemic to malaria caused by Plasmodium falciparum. To reduce the death rate due to this scourge, it is essential to ensure quality care, especially for children under five years who are the most vulnerable. The main objective of this study is to assess the quality of severe malaria case management in patients under five years. Methods: Descriptive and analytical cross-sectional study was performed in health facilities in Cotonou city, the economic capital of Benin Republic. Study sample included 205 suspected cases of severe malaria among children aged under five years, in four health facilities. In each of hospitals, all children under five years with severe malaria presumption were enrolled in the study. Quality was assessed through five components: diagnosis, treatment, patient monitoring, counselling/advice, and patient’s follow-up. Based on the Benin Republic’s malaria case management standard protocol, the assessment criteria of each component were defined. Results: The sex ratio was 1.25 boys to a girl. The median of hospitalisation duration was 3 days with first quartile (Q1) = 2 and third quartile (Q3) = 5. Among 205 severe malaria cases included, 157 (76.59%) were not managed in accordance with the requirements of the national protocol of malaria case management. The different components of cases management are not all implemented during the care of patients. Conclusion: There is a need for training to health workers on implementation of severe malaria in children under 5 years protocol. Also, there is a need for investigation about factors associated with malaria protocol implementation.

Clinical profile and renal complications among cases of malaria in children attending a tertiary care hospital of South India

Background: Malaria is one of the major vectors borne disease globally responsible for 1 million deaths a year. Changing trends in the causative species and epidemiological distribution have identified icterus and renal involvement as an emerging complication associated with severe mortality in children. The objectives of this study were aimed to study the clinical profile of malaria cases admitted in a pediatric ward. The study also highlights the involvement of renal manifestations in the cases with regard to species distribution and associated complications in the study group.Methods: A prospective study for 14 months was conducted, and all positive cases of malaria admitted in paediatric unit were enrolled and socio demographic data, clinical history were collected, and biochemical investigations were performed and analyzed. SPSS software version 12 was used for analysis. Statistical significance was set at p ≤0.05.Results: About 278 subjects with 55.4% males, 44.6% females and with 5-10 years was most common age group. 102 cases of vivax malaria, 152 cases were falciparum and 24 were mixed cases. Cerebral malaria, hyperparasitemia was identified in 28 cases, DIC in 5.04% of cases. Renal involvement was observed in 38.16% of falciparum infections and 27.45% of vivax infections. 68 cases developed acute renal failure as a severe complication.Conclusions: Renal involvement is more in falciparum and mixed infections than vivax malaria. Early diagnosis and prompt treatment help in early recovery of cases and halts to progression to renal failure. An urgent need for a biomarker for early identification of renal involvement in malaria before biochemical involvement is detected.

Case Definitions of Clinical Malaria in Children from Three Health Districts in the North Region of Cameroon.

Malaria endemicity in Cameroon greatly varies according to ecological environment. In such conditions, parasitaemia, which is associated with fever, may not always suffice to define an episode of clinical malaria. The evaluation of malaria control intervention strategies mostly consists of identifying cases of clinical malaria and is crucial to promote better diagnosis for accurate measurement of the impact of the intervention. We sought out to define and quantify clinical malaria cases in children from three health districts in the Northern region of Cameroon. A cohort study of 6,195 children aged between 6 and 120 months was carried out during the raining season (July to October) between 2013 and 2014. Differential diagnosis of clinical malaria was performed using the parasite density and axillary temperature. At recruitment, patients with malaria-related symptoms (fever [axillary temperature ≥ 37.5°C], chills, severe malaise, headache, or vomiting) and a malaria positive blood smear were classified under clinical malaria group. The malaria attributable fraction was calculated using logistic regression models. Plasmodium falciparum was responsible for over 91% of infections. Children from Pitoa health district had the highest number of asymptomatic infections (45.60%) compared to those from Garoua and Mayo Oulo. The most suitable cut-off for the association between parasite densities and fever was found among children less than 24 months. Overall, parasite densities that ranged above 3,200 parasites per μl of blood could be used to define the malaria attributable fever cases. In groups of children aged between 24 and 59 months and 60 and 94 months, the optimum cut-off parasite density was 6,400 parasites per μl of blood, while children aged between 95 and 120 months had a cut-off of 800 parasites per μl of blood. In the same ecoepidemiological zone, clinical malaria case definitions are influenced by age and location (health district) and this could be considered when evaluating malaria intervention strategies in endemic areas.

Praktek Pencegahan Penularan Malaria pada Balita di Puskesmas Kabukarudi Sumba Barat

Malaria is the infection disease wich is caused by parasite genus plasmodium which is infected eritrosit. Kabukarudi Health Center has the highest cases of malaria in West Sumba. Malaria on 2015 were approximately 240 cases of which most cases happend in children under five years old. The research aims to to know the effect of nutrient, application of repellent and the usage of mosquito nets in Kabukarudi Health Center in Lamboya District of West Sumba. The research was case control study with the sample of 45 children infected by malaria and 45 uninfected children. The research instrument used was questionnaire and data were analyzed by Chi-Square. The result showed that the nutrient status had no effect on Malaria (p=0,383; OR=2), while repellent application (p=0, 007., OR=4,047) and mosquito net usage (p=0, 000; OR=6,484), influenced malaria cases in children. Health workers need to deliver information about the benefits of repellent and usage of mosquito nets to communities, especially to mother to help prevent malaria in children.

Nonseasonal ARIMA Modeling and Forecasting of Malaria Cases in Children under Five in Edum Banso Sub-district of Ghana

Nonseasonal ARIMA Modeling and Forecasting of Malaria Cases in Children under Five in Edum Banso Sub-district of Ghana

Effectiveness of insecticidal nets on uncomplicated clinical malaria: a case-control study for operational evaluation.

BackgroundIn a context of large-scale implementation of malaria vector control tools, such as the distribution of long-lasting insecticide nets (LLIN), it is necessary to regularly assess whether strategies are progressing as expected and then evaluate their effectiveness. The present study used the case–control approach to evaluate the effectiveness of LLIN 42 months after national wide distribution. This study design offers an alternative to cohort study and randomized control trial as it permits to avoid many ethical issues inherent to them.MethodsFrom April to August 2011, a case–control study was conducted in two health districts in Benin; Ouidah–Kpomasse–Tori (OKT) in the south and Djougou–Copargo–Ouake (DCO) in the north. Children aged 0–60 months randomly selected from community were included. Cases were children with a high axillary temperature (≥37.5 °C) or a reported history of fever during the last 48 h with a positive rapid diagnostic test (RDT). Controls were children with neither fever nor signs suggesting malaria with a negative RDT. The necessary sample size was at least 396 cases and 1188 controls from each site. The main exposure variable was “sleeping every night under an LLIN for the 2 weeks before the survey” (SL). The protective effectiveness (PE) of LLIN was calculated as PE = 1 − odds ratio.ResultsThe declared SL range was low, with 17.0 and 27.5 % in cases and controls in the OKT area, and 44.9 and 56.5 % in cases and controls, in the DCO area, respectively. The declared SL conferred 40.5 % (95 % CI 22.2–54.5 %) and 55.5 % (95 % CI 28.2–72.4 %) protection against uncomplicated malaria in the OKT and the DCO areas, respectively. Significant differences in PE were observed according to the mother’s education level.ConclusionIn the context of a mass distribution of LLIN, their use still conferred protection in up to 55 % against the occurrence of clinical malaria cases in children. Social factors, the poor use and the poor condition of an LLIN can be in disfavour with its effectiveness. In areas, where LLIN coverage is assumed to be universal or targeted at high-risk populations, case–control studies should be regularly conducted to monitor the effectiveness of LLIN. The findings will help National Malaria Control Programme and their partners to improve the quality of malaria control according to the particularity of each area or region as far as possible.

Malaria in immigrant and traveler children: Clinical presentation and risk factors for complications

To review the clinical features and risk factors for complications and treatment of malaria in a pediatric cohort mainly composed of immigrant children. Retrospective cohort study of all cases of malaria diagnosed between 1991 and 2001 in Montreal, Canada. We have reviewed a total of 121 cases of malaria in children. The majority of which (78%) were immigrants or foreign-born visitors. Most children were originating from African countries and mainly infected with Plasmodium falciparum (63.9%, versus 21.0%, 5.9%, 3.4% for Plasmodium vivax), Plasmodium ovale and Plasmodium malariae respectively). Seven patients (5.9%) were co-infected with more than one species. Median times from arrival to presentation were much shorter with P. falciparum (14 days) than other species: P. vivax (98 days), P. ovale (37 days) and P. malariae (31 days). The majority of children had fever, headache and rigors. Ten children (8.3%) had serious complications (cerebral malaria, anemia or shock). All ten patients presented within one month of arrival from their respective endemic country and all were infected with P. falciparum (P = 0.03). Three patients required admission to a pediatric intensive care unit and seven required a blood transfusion. All recovered well although two children had P. falciparum recrudescence and three children infected with P. vivax or P. ovale relapsed. The number of complications observed in immigrant children was similar to that observed in travelers. Sickle cell disease was the most significant associated risk factor for serious complications of malaria (P

Outbreak of malaria in an indigenous population living in an urban area of Armenia, Colombia, 2012

Malaria is the most frequent mosquito-borne parasitic infection in the tropical regions of the world. Due to different factors, including climate change, this disease can emerge or reemerge in different areas in the planet. To describe an autochthonous outbreak of urban malaria in Armenia, Colombia. After two children consulted a second level hospital located in the south of Armenia with malaria symptoms and their diagnosis was confirmed through the presence of Plasmodium vivax trophozoites detected by a positive thick blood smear, a visit was conducted to the residence of the children. An active search for cases was carried out, the environmental and sociocultural conditions were described and mosquito larvae and pupae were collected and identified. Control measures were implemented and their effectiveness was evaluated as well. The active search in the community allowed the identification of 11 probable cases, three of which were P. vivax malaria cases in children confirmed by blood microscopy. The entomological analysis of mosquito larvae and pupae showed Anopheles spp., Anopheles punctimacula and Anopheles argyritarsis. This is the first report of an autochthonous malaria outbreak by P. vivax in the city of Armenia, associated with the subnormal settlement of an indigenous community. The banks of the Quindío river offer the eco-epidemiological conditions that allow the establishment of the reproductive cycle of the malaria mosquito vector.

Descripción de un brote epidémico de malaria en una comunidad indígena asentada en la zona urbana de Armenia, Quindío. Colombia 2012

Malaria is the most frequent mosquito-borne parasitic infection in the tropical regions of the world. Due to different factors, including climate change, this disease can emerge or reemerge in different areas in the planet.To describe an autochthonous outbreak of urban malaria in Armenia, Colombia.After two children consulted a second level hospital located in the south of Armenia with malaria symptoms and their diagnosis was confirmed through the presence of Plasmodium vivax trophozoites detected by a positive thick blood smear, a visit was conducted to the residence of the children. An active search for cases was carried out, the environmental and sociocultural conditions were described and mosquito larvae and pupae were collected and identified. Control measures were implemented and their effectiveness was evaluated as well.The active search in the community allowed the identification of 11 probable cases, three of which were P. vivax malaria cases in children confirmed by blood microscopy. The entomological analysis of mosquito larvae and pupae showed Anopheles spp., Anopheles punctimacula and Anopheles argyritarsis.This is the first report of an autochthonous malaria outbreak by P. vivax in the city of Armenia, associated with the subnormal settlement of an indigenous community. The banks of the Quindío river offer the eco-epidemiological conditions that allow the establishment of the reproductive cycle of the malaria mosquito vector.

Clinical and Epidemiological Profiles of Severe Malaria in Children from Delhi, India

Plasmodium vivax is traditionally known to cause benign tertian malaria, although recent reports suggest that P. vivax can also cause severe life-threatening disease analogous to severe infection due to P. falciparum. There are limited published data on the clinical and epidemiological profiles of children suffering from 'severe malaria' in an urban setting of India. To assess the clinical and epidemiological profiles of children with severe malaria, a prospective study was carried out during June 2008-December 2008 in the Department of Pediatrics, Guru Teg Bahadur Hospital, a tertiary hospital located in East Delhi, India. Data on children aged < or = 12 years, diagnosed with severe malaria, were analyzed for their demographic, clinical and laboratory parameters. All patients were categorized and treated as per the guidelines of the World Health Organization. In total, 1,680 children were screened for malaria at the paediatric outpatient and casualty facilities of the hospital. Thirty-eight children tested positive for malaria on peripheral smear examination (2.26% slide positivity rate). Of these, 27 (71%) were admitted and categorized as severe malaria as per the definition of the WHO while another 11 (29%) received treatment on outpatient basis. Most (24/27; 88.8%) cases of severe malaria (n=27) were infected with P. vivax. Among the cases of severe malaria caused by Plasmodium vivax (n=24), 12 (50%) presented with altered sensorium (cerebral malaria), seven (29.1%) had severe anaemia (haemoglobin <5 g/dL), and 17 (70.8%) had thrombocytopaenia, of which two had spontaneous bleeding (epistaxis). Cases of severe vivax malaria are clinically indistinguishable from severe falciparum malaria. Our study demonstrated that majority (88.8%) of severe malaria cases in children from Delhi and adjoining districts of Uttar Pradesh were due to P. vivax-associated infection. P. vivax should, thus, be regarded as an important causative agent for severe malaria in children.

Lack of Evidence of Myocardial Damage in Children with Plasmodium falciparum Severe and Complicated Malaria from an Endemic Area for Endomyocardial Fibrosis

Malaria is among the factors thought to be involved in the pathogenesis of endomyocardial fibrosis (EMF), a restrictive cardiomyopathy of unclear etiology, with no specific therapy, which affects predominantly children and adolescents. In Africa, regions endemic with EMF are also areas with high prevalence of malaria. We studied 47 consecutive children aged 5- to 15-years old and concluded that myocardial damage and dysfunction are rare in severe and complicated Plasmodium falciparum malaria cases in children.

Sitios de cría y actividad de picadura de especies de anopheles en el municipio de Cimitarra, Santander, Colombia.

Forty five percent of malaria cases in the department of Santander, Colombia originate in the municipality of Cimitarra. This locality has reported cases from the rural and urban areas. The population between 15 and 45 years of age is the most affected. Additionally, Cimitarra has registered malaria cases in children under 1 year of age. To determine the biology and behavioral aspects of Anopheles mosquitoes from Cimitarra to more effectively orient control strategies. During October to December/2002 and March/2003, anopheline collections were undertaken. Isofamilies were obtained from 620 wild females. The following species were found in order of abundance: Anopheles (Nyssorhynchus) triannulatus (Neiva y Pinto 1922), Anopheles (Nyssorhynchus) nuneztovari Gabaldón 1940, Anopheles (Nyssorhynchus) rangeli Gabaldón, Cova-García y López 1940, Anopheles (Anopheles) pseudopunctipennis Theobald 1901, Anopheles (Anopheles) mattogrosensis Lutz y Neiva 1911 and Anopheles (Anopheles) neomaculipalpus Curry 1933. The highest biting rate (0.5) was recorded for An. nuneztovari and An. triannulatus indoors between 20-21 hours. Forty two breeding places were sampled, 81% were fish ponds, 9.5% puddles and 2.3% cement tanks. Eighty seven percent of fish ponds were located near dwellings, being positive for anopheline larvae. This study has shown that in Cimitarra cryptic and sister species of Anopheles genus occur in sympatry, Nyssorhynchus subgenera.