Age as a risk factor for thrombocytopenia and anaemia in children treated for acute uncomplicated falciparum malaria.

BACKGROUND & OBJECTIVES: Anaemia is commonly observed in children with malaria, but reports on leucocyte and platelet count abnormalities associated with malaria are inconsistent. This study examined the effect of age, gender, parasite density and temperature on haematological parameters in children with acute uncomplicated malaria. METHODS: Haematological parameters were determined in children with acute uncomplicated malaria, and these were correlated with age, sex, temperature and parasite density. Statistical analysis was done using SAS 9.1. RESULTS: Six hundred and ninety five children with acute uncomplicated malaria participated in the study. The mean age was 51.7 months +/- 33.8. At presentation, anaemia occurred in 43.8% of the patients and children <5 yr had a significantly lower haematocrit (28.4% +/- 4.8) than that of older children (32.8% +/- 4.8) (p <0.001), but the haematocrit was not significantly different by days 14 and 28. There was no difference between both sexes. Leucocytosis was more frequently seen than leucopenia (9.5% vs 3%). Thrombocytopenia was found in 59.3% of enrolled patients. More than half of the patients with thrombocytopenia had recovered by Day 28. Baseline platelet count was related to Day 14 (r = 0.6, p < 0.0001) and Day 28 (r = 0.2, p = 0.0015) and the haematocrit on Day 28 (r = 0.12, p = 0.00197). Platelet count showed no correlation with temperature, parasite density and leucocyte count. Haematocrit correlated with age (r = 0.4, p < 0.0001); but not with parasite density or temperature. Leucocyte count showed no correlation with age or parasite density. CONCLUSION: While thrombocytopenia was the most common haematological finding and may be of diagnostic importance, anaemia and leucocytosis were more common in the under fives.

Asymptomatic malaria parasitaemia in sickle-cell disease patients: how effective is chemoprophylaxis?

BACKGROUND & OBJECTIVES: Sickle-cell trait confers protection against malaria while homozygote sickle-cell disease (SCD) patients are at greater risk of malaria infection, hence the use of malaria chemoprophylaxis in SCD patients. The use of malaria chemoprophylaxis and asymptomatic parasitaemia were studied in SCD and non-SCD patients. STUDY DESIGN: A semi-structured questionnaire was administered to both patients and controls; a thick blood film was also examined in both the groups. RESULTS: Sixty-nine percent of patients use proguanil, 22% do not use any form of chemoprophylaxis, while 9% use pyrimethamine. There was no significant difference between level of parasitaemia in patients and controls (p = 0.1), a positive smear was found in equal numbers of patients on chemoprophylaxis and those not on chemoprophylaxis (p = 0.3). In the month preceding the study, 31% of patients vs 18% of controls had received treatment for malaria. There were no significant differences between patients and controls in frequency of malaria attacks (p = 0.06), last episode of malaria (p = 0.2). Ten percent of patients and 2% of controls use bednets. CONCLUSION: This study did not find any advantage in the use of malaria chemoprophylaxis in SCD patients over controls or SCD patients not on chemoprophylaxis. Vector control should also be considered in the fight against malaria. There is a need to look into why both patients and controls fail to use bednets in a malaria endemic country.