Malaria in

Children
Department of Paediatrics -and
a brief
Childoverview
Health,
Mbarara University
 Outline
 Theburden and public health impact of malaria in children
 Clinical
presentation
 Recognition/clinical diagnosis
 Approach to treatment
Burden
 In Uganda, U5 child can have 6 episodes of
clinical malaria
 Malaria accounts for about 70% of outpatient
attendances in children under 5
 Accounts for 50% of admissions in under 5 in
Uganda
 In MRRH malaria accounts for about 60% of
paediatric admissions
Mortality
 Especially in children, malaria is a rapidly progressive and
frequently fatal illness.
 Case fatality rate for severe malaria is 10-25%
 Majority of the deaths occur within 1-2 days of the onset of
symptoms
 Although there may be background co-morbidity, malaria
frequently kills previously healthy children
Mortality
 Malaria is the main killer of children in Uganda
 Or 70,000-110,000 child deaths per year
 In MRRH malaria was the recorded diagnosis in 57.6% of
deaths registered over the 12-month period March 2006 – Feb
2007
Mortality
 Malaria also contributes to infant mortality
through its impact on birth weight: low birth
weight (LBW) is a major factor in infant mortality
 In hyperendemic areas, maternal malaria is the
main cause of low birth weight
 The excess risk of LBW among PGs over that in
MGs is directly proportional to the level of malaria
transmission in the area.
Other impact
 Malaria is also an important cause of chronic morbidity
 Recurrent – chronic anaemia
 Associated with growth restriction (stunting)
 Associated with retardation of cognitive development in
children
 Numerous neurological sequelae following cerebral malaria
Clinical presentation
 Age:
 Congenital malaria extremely rare
 Clinical malaria generally rare below 2 months
 Highest incidence is 3 months to 5 years
2 broad categories: uncomplicated and
complicated malaria
Clinical recognition
 Early childhood is the period of highest incidence of infections
generally. Fever can be due to a wide range of infections
 Most infections present with non-specific features, in a way
that is difficult to distinguish from malaria
 In young children (asymptomatic) malaria parasitaemia
prevalence can be as high as 50-80%, and 20-50% in older
children.
Common symptoms
 Fever:
 Typically acute onset, short history
 Variable, can be moderate or high grade
 Classical patterns of tertian or quartan variation
unusual in children
 Often have clear fever-free periods
 Shivering/rigors also unusual especially in infants
 May be associated with febrile seizures
Common symptoms and signs
 Symptoms generally non-specific
 Vomiting
 Reduced appetite
 Cough
 Diarrhoea
 Often a degree of pallor (anaemia)
 Frequently enlarged spleen and liver
 Other symptoms/signs reflect the emergence of
various complications
Important complications
 Cerebral malaria
 Seizures; due to various factors
 Anaemia (haemolytic)
 Metabolic acidosis
 Hypoglycaemia
 Pulmonary oedema
Thank you