Malaria morbidity in Sindh and the plasmodium species distribution

To determine the prevalence of Malarial parasites and species responsible in Sindh Province of Pakistan. It is a cross sectional descriptive study conducted in all Districts of Sindh during January 2002 to December 2006. It was based on surveillance data of Malaria control program Sindh in which blood smears from febrile cases in all age group of male and female were seen by facility microscopist in all districts. Senior microscopist rechecked all positive slides. All slides data of different districts of Sindh was reported on monthly basis to provisional centre at Hyderabad for compiling and analysis. During 2002-2006, out of 5.84 million slides, those with positive malarial parasites were approx. 0.16 million giving an average blood examination rate [BER] 4.46, slide positivity rate [SPR] 2.94, Falciparum ratio[FR] was 41%, annual parasite incidences [API] was 1.36. More cases were seen in post monsoon season. All basic indicators of Malaria disease are higher than optimum level. Estimated burden can be much higher, Roll Back Malaria goals are lagging far behind to reduce the disease burden. As such integrated approach of diagnosis, treatment and prevention is required

Recurrent abdominal pain in children

To determine the causes of recurrent abdominal pain [RAP] in children and suggest general management guidelines. It is a descriptive observational study conducted from August 2000 to July 2003.One hundred fifty two children of 2- 15-Years age with recurrent abdominal pain were enrolled in this study. A pre-designed proforma was filled and investigations like Complete Blood Count [CBC], urine and fresh stool analysis was performed in all cases. Patients presenting with upper abdominal pain with or without dyspeptic symptoms were evaluated for H. Pylon by serology. Helicobacter pylon antibody serology [value >50 i.u Elisa method] positive patients were offered endoscopy examination and endoscopic antral biopsies were done. Other tests like x-ray chest and or abdomen, barium meal study, ultrasonography of abdomen, EEG examination and tuberculin test were done as indicated. Patients were followed at 2-week interval for three months and specific treatment prescribed as per etiology identified. Out of 152 children, a female to male ratio was 2:1, age range was 2-15 years and mean age was 8.9 years. Mean duration of symptoms was 16 months. Patients presented with epigastric localization of pain 65%, 25% presented with 'whole' abdominal pain while 5% patients presented with pain in loins and 5% had pain in tower abdomen. Protozoal infections which included giardiasis and amoebiasis [33%] were the commonest association followed by Helicobacter pylon [31%]. Endoscopy was performed in 15 cases; biopsy was positive for H.Pylori in all [100%] cases. Thirteen percent had worms in addition to giardia and entamoeba histolytica and 10% had gastro-esophageal reflux. Among other causes urinary tract infection was 5%, constipation was 3% a peptic ulcer diseases was 02%. Abdominal epilepsy, abdominal migraine, cholilithiasis, ovarian cyst, ulcerative colitis and gastnic-trichobizoar all were less than 1%. Recurrent abdominal pain is frequent and challenging pediatric problem. High index of suspicion and careful thorough clinical evaluation supported by stepwise laboratory work-up according to it's clinical presentation and consideration of common treatable causes will be a cost effective approach. Balanced diet with higher fiber content, environmental cleanliness, better quality of water and good personal hygiene practices can reduce common infections with causative factors