[Relationship between Plasmodium parasitemia and febrile episodes in various population groups in Kinshasa, Zaire]. / Relation entre parasitémie à Plasmodium et accès fébrile dans différents groupes de population à Kinshasa, Zaire.

The objective of this study was to determine the relative importance of determinants of fever-episodes in an environment with perennial malaria transmission. In 6 neighbourhoods of Kinshasa with different degrees of urbanization, 120 clusters of children younger than 10 years were selected over a one year period and followed up for 2 weeks each. In the 4,816 children retained for analysis 906 fever episodes were registered, which corresponds to an average incidence rate of 4.9 episodes per child per year. Seven hundred (77.3%) of the fever cases had a positive thick film (IF) but of the 3,289 children with a positive TF only 21.3% presented fever during the observation period. Nevertheless, high parasite densities formed, without neglecting the role of other infectious etiologies, the mayor pathogenic mechanism associated with fever. The risk for a fever episode was, in multivariate analysis, 40 times higher in children with at least one positive TF than in children with a negative TF on both day 1 and day 14, and amongst the ones with a positive TF the risk was 3 times higher in children with a parasitemia above 3,000 trophozoites/microliter blood. The habitat constituted another important independent determinant: the relative risk for fever was 1.48 for non-urbanized neighbourhoods, which probably reflects the low malaria transmission in the urbanized ones, but 2.1 for semi-urbanized against peripheral neighbourhoods, where the parasite index is high. Low socio-economic status, the short dry season and young age formed, in this order, further factors to the take into account.

[Childhood malaria in Kinshasa (Zaire). Influence of seasons, age, environment, and family social conditions]. / Le paludisme de l'enfant à Kinshasa (Zaïre). Influence des saisons, de l'âge, de l'environnement et du standing familial.

Frequency of malaria in children was evaluated from march 1986 to February 1987 in six districts of Kinshasa by paludometric survey with multiple visits. The six districts were selected according to their geographical situation and their degree of urbanisation. Each month, two stocks of children from 0 to 10 years old dwelling in a street were selected district and visited twice randomization in each selected district and visited twice at 2 weeks of interval. 5,541 children were examined at the occasion of the second visit. Influence of seasons, age, district, socio-economic level of the family and level of education of the parents was determined by analysing the following parameters: plasmodial index, parasitic density, incidence of fever attacks, conversion rate of thick smear, antimalaria drug consumption. Parasitic prevalence is 50 p.c. annual incidence of fever attacks is 50 p.c. and annual frequency of antimalaria drugs is 3,64 per child. Dry seasons (June-September and January-February) ease the pathophoresis and pathogenicity of plasmodia. The age group of less than one year is relatively less parasitized but from 2 years, contact with parasites is very high and without any significant evolution up to 10 years. The district where a child is living plays a predominant role on paludometric indices. Transmission is deeply influenced by geographical situation in the center of the town or in outlying districts and by the socio-economic environment (basic equipment, streets conditions, quality of accommodation). The socio-economic level of the child's family is also important in regard to malaria prevention. The level of education of the parents and mainly the mother has the greatest influence.