ABSTRACT
Objective: To study the presentations of afebrile malaria with respect to febrile malaria. Study Design: Cross sectional descriptive. Place and Duration of Study: Combined Military Hospital [CMH] Mangla Cantt, from Jan 2015 to Jan 2017
Material and Methods: A retrospective cross sectional descriptive study was conducted on patients received at CMH Mangla during the study period. Permission from the ethical committee of hospital was obtained for the study. Malaria was diagnosed by exam of peripheral blood film slide on Leishman, s stain. Typing of the parasite was done using ICT immunochromatographic strip test. All consecutively advised malarial parasite [MP] tests on febrile and afebrile patients were included in the study. All repeated MP test on the same patients were excluded from the study. No co-incidental/asymptomatic case was diagnosed or included in the study
Results: A total of 5372 MP tests of patients were advised out of which total 1120 cases were reported positive for malaria infection during above study period. A total of 205 cases of suspected afebrile malarial patients were advised MP test. Out of which 116 cases of afebrile malaria were confirmed at Lab. The percentage ratio of total positive MP test was 21%. The ratio of positive febrile to afebrile total MP positive cases was 10:1. Among 116 afebrile patients the presentations were refractory anemia in 42 cases, elevated ALT in 35 cases thrombocytopenia in 3 cases, and jaundice in 8 cases. All presentations of afebrile malarial patients were normalized after antimalarial treatment. Data were analyzed in excel. Descriptive statistics was applied on qualitative variables. Frequency and percentage documented
Conclusion: Malaria without fever is a statistically significant cause of morbidity among patients. Although simple to diagnose and easy to treat, omission of lab diagnosis leads to accumulation of untreated cases of afebrile malaria who are advised expensive and time wasting investigations burdening the Medicare system
ABSTRACT
To find out an association between undernutrition and severity of pneumonia in children under five years of age. The study was carried out at paediatric department of Military Hospital Rawalpindi. From August 2003 to January 2004. Cross sectional analytical study. Children of either gender from 2 to 59 months of age with the clinical diagnosis of pneumonia made according to WHO guidelines were classified into various grades of nutritional status with referrence to the NCHS standards for weight for age. Five hundred children, including 280 [56%] boys and [220] 44% girls with the mean age 20.36 [ +/- 14.26] months were evaluated. One hundred and ninety five [39%] had pneumonia, 158 [31.6%] had severe pneumonia, whereas 147 [29.4%] had very severe pneumonia. Two hundred and eighty six [57.2%] children were normally nourished whereas 214 [42.8%] were undernourished; 133/214 [62.1%] had moderate and 81/214 [37.9%] had severe undernutrition. Fever [81%], cough [77%], nasal flaring [76%], tachypnoea and chest indrawing [61%] were the commonest presentations. The mean hospital stay was 6.9 [ +/- 2.65] days. Thirteen [2.6%] patients including 5 [38.5%] boys and 8 [61.5%] girls, who all were undernourished, expired. The relative risk of death in undernourished children was 1.065 times [95%CI= 1.029 to 1.102] that of normally nourished children [p<0.0001]. Younger age, severity of pneumonia and undernutrition are significant risk factors for morbidity, prolonged hospitalization and mortality in young children with pneumonia