Childhood Febrile Illness, Are We Over Diagnosing Malaria?

Abstract

Malaria and bacterial infections are major causes of febrile illness in the developing world. To investigate the contribution of malaria and concurrent bacterial infection to febrile illness in children, 50 children aged 6 to 60 months, who presented with fever 37.5 C (axillary) or above at the Dodowa Health Center, a primary care center between July and August (wet season) 2003 were enrolled into a study. The most common presenting signs were vomiting (54%), inability to suck or eat (56%) liver enlargement (48%) and pale conjunctivae (48%). The mean axillary temperature recorded was 38.53 C (SD 2.889). The highest recorded temperature was 40 C (in 8% of cases). Ninety-six percent (96%) of participants had positive blood smears for malaria parasites, but only 28 % had parasite densities above 2500/µl (clinical malaria). All positive smears had plasmodium falciparum species. The mean parasite density was 3541.74 counts per µl (minimum and maximum parasite densities were 80 and 28,800 counts per µl respectively). Of those who had presenting axillary temperature 40 C or above (N=4), two had no bacterial growth; one had mixed bacterial growth (of acute phase blood culture), which was more probably due to contamination of the sample with skin flora, whiles one had positive streptococcal spp growth. Sixty percent (60%) of the children had been given some sort of treatment before presentation, Thirty percent (30%) were given antimalarial (chloroquine) but only 15% receive adequate doses. Two percent were given antibiotics. it is recommended that caregiver education on the prevention and proper management of fever be intensified. There is also the need for more research into malaria and concurrent bacterial infection.