Clinical algorithm for malaria during low and high transmission seasons
Lulu Muhea, Birhane Oljiraa, Hirut Degefua, Fikre Enquesellassieb, Martin W Weberc
a Department of
Paediatrics and Child Health, PO Box 1768, Addis Ababa University,
Addis Ababa, Ethiopia, b Department of Community Health, PO Box 1176, Addis Ababa University, c Department of Child and Adolescent Health and
Development, World Health Organisation, CH-1211 Geneva 27, Switzerland
Correspondence to: Dr Muhe.
Accepted 12 April 1999
OBJECTIVES
To assess
the proportion of children with febrile disease who suffer from malaria
and to identify clinical signs and symptoms that predict malaria during
low and high transmission seasons.
STUDY DESIGN2490
children aged 2 to 59 months presenting to a health centre in rural
Ethiopia with fever had their history documented and the following
investigations: clinical examination, diagnosis, haemoglobin
measurement, and a blood smear for malaria parasites. Clinical findings
were related to the presence of malaria parasitaemia.
RESULTSMalaria
contributed to 5.9% of all febrile cases from January to April and to
30.3% during the rest of the year. Prediction of malaria was improved
by simple combinations of a few signs and symptoms. Fever with a
history of previous malarial attack or absence of cough or a finding of
pallor gave a sensitivity of 83% in the high risk season and 75% in
the low risk season, with corresponding specificities of 51% and 60%;
fever with a previous malaria attack or pallor or splenomegaly had
sensitivities of 80% and 69% and specificities of 65% and 81% in
high and low risk settings, respectively.
CONCLUSIONBetter
clinical definitions are possible for low malaria settings when
microscopic examination cannot be done. Health workers should be
trained to detect pallor and splenomegaly because these two signs
improve the specificity for malaria.
Keywords: developing countries; malaria; epidemiology; clinical signs
© 1999 by Archives of Disease in Childhood
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