CLINICAL PREDICTORS OF MALARIA IN THE UNDER FIVES THAT PRESENT WITH FEVER IN E.C.W.A. EVANGEL HOSPITAL, JOS, PLATEAU STATE

Abstract

Malaria control continues to rely on the diagnosis and prompt treatment of both suspected
and confirmed cases through the health care structures. The absence of microscopic
examination in most of the health facilities implies that health workers must rely on clinical
suspicion to identify the need of treatment for malaria.

AIM AND OBJECTIVES: To assess the proportion of children with fever who suffer
from malaria and to identify clinical signs and symptoms that predict malaria in ECWA
Evangel Hospital, Jos.

STUDY. Jos.

STUDY. DESIGN: A total of 184 subjects, children below age of five years who presented
with fever or history of fever were enrolled into the study in the ECWA Evangel Hospital,
Jos Outpatient Department. The study was done over 3 months period from May to July
2003. For every subject a history of the illness was obtained by asking for specific
symptoms and clinical examination conducted and relevant clinical features were noted.
The following investigations were done: packed cell volume and blood smear for malaria
parasites. Clinical findings were related to the presence of malaria parasitaemia.

RESULTS: Malaria contributed to 39.1% of all febrile cases in the under fives that
presented with fever in ECWA Evangel Hospital Jos. Loss of appetite gave a sensitivity of
75% in predicting malaria and specificity of 45%, sweating and rectal temperature
=>38.6oC gave a sensitivity value of 46% and 56% in predicting malaria with a
corresponding specificity of 43% and 52% respectively. Splenomegaly and hepatomegaly
gave 78% and 75% sensitivity in predicting malaria with specificity values of 19% and 14%
respectively. The mean temperature for parasitaemic subjects was 38.60C while the mean
2
parasite density was 5,093 parasites per microlitre of blood. When the signs and symptoms
that have high sensitivity were subjected to a logistic regression analysis to see their
association with malaria parasitaemia none had good correlation coefficient.

CONCLUSION: It is concluded that fever or history of fever was strongly associated with
malaria, but a high accuracy of malaria diagnosis in febrile children requires microscopical
examination.

CLINICAL PREDICTORS OF MALARIA IN THE UNDER FIVES THAT PRESENT WITH FEVER IN E.C.W.A. EVANGEL HOSPITAL, JOS, PLATEAU STATE