Skip to main content
PMC home page
Archives of Disease in Childhood logoLink to Archives of Disease in Childhood
. 1999 Sep;81(3):216–220. doi: 10.1136/adc.81.3.216

Clinical algorithm for malaria during low and high transmission seasons

L Muhe 1, B Oljira 1, H Degefu 1, F Enquesellassie 1, M Weber 1
PMCID: PMC1718069  PMID: 10451393

Abstract

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 DESIGN—2490 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.
RESULTS—Malaria 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.
CONCLUSION—Better 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.



Full Text

The Full Text of this article is available as a PDF (93.9 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Daniel E., Beyene H., Tessema T. Relapsing fever in children--demographic, social and clinical features. Ethiop Med J. 1992 Oct;30(4):207–214. [PubMed] [Google Scholar]
  2. Delfini L. F. The relationship between body temperature and malaria parasitaemia in rural forest areas of Western Nigeria. J Trop Med Hyg. 1973 May;76(5):111–114. [PubMed] [Google Scholar]
  3. Genton B., Smith T., Baea K., Narara A., al-Yaman F., Beck H. P., Hii J., Alpers M. Malaria: how useful are clinical criteria for improving the diagnosis in a highly endemic area? Trans R Soc Trop Med Hyg. 1994 Sep-Oct;88(5):537–541. doi: 10.1016/0035-9203(94)90152-x. [DOI] [PubMed] [Google Scholar]
  4. Gjørup T., Bugge P. M., Hendriksen C., Jensen A. M. A critical evaluation of the clinical diagnosis of anemia. Am J Epidemiol. 1986 Oct;124(4):657–665. doi: 10.1093/oxfordjournals.aje.a114438. [DOI] [PubMed] [Google Scholar]
  5. Greenwood B. M., Armstrong J. R. Comparison of two simple methods for determining malaria parasite density. Trans R Soc Trop Med Hyg. 1991 Mar-Apr;85(2):186–188. doi: 10.1016/0035-9203(91)90015-q. [DOI] [PubMed] [Google Scholar]
  6. Greenwood B. M. Asymptomatic malaria infections--do they matter? Parasitol Today. 1987 Jul;3(7):206–214. doi: 10.1016/0169-4758(87)90061-5. [DOI] [PubMed] [Google Scholar]
  7. Grover S. A., Barkun A. N., Sackett D. L. The rational clinical examination. Does this patient have splenomegaly? JAMA. 1993 Nov 10;270(18):2218–2221. [PubMed] [Google Scholar]
  8. Jonkman A., Chibwe R. A., Khoromana C. O., Liabunya U. L., Chaponda M. E., Kandiero G. E., Molyneux M. E., Taylor T. E. Cost-saving through microscopy-based versus presumptive diagnosis of malaria in adult outpatients in Malawi. Bull World Health Organ. 1995;73(2):223–227. [PMC free article] [PubMed] [Google Scholar]
  9. Luxemburger C., Nosten F., Kyle D. E., Kiricharoen L., Chongsuphajaisiddhi T., White N. J. Clinical features cannot predict a diagnosis of malaria or differentiate the infecting species in children living in an area of low transmission. Trans R Soc Trop Med Hyg. 1998 Jan-Feb;92(1):45–49. doi: 10.1016/s0035-9203(98)90950-6. [DOI] [PubMed] [Google Scholar]
  10. Nardone D. A., Roth K. M., Mazur D. J., McAfee J. H. Usefulness of physical examination in detecting the presence or absence of anemia. Arch Intern Med. 1990 Jan;150(1):201–204. [PubMed] [Google Scholar]
  11. O'Dempsey T. J., McArdle T. F., Laurence B. E., Lamont A. C., Todd J. E., Greenwood B. M. Overlap in the clinical features of pneumonia and malaria in African children. Trans R Soc Trop Med Hyg. 1993 Nov-Dec;87(6):662–665. doi: 10.1016/0035-9203(93)90279-y. [DOI] [PubMed] [Google Scholar]
  12. Olaleye B. O., Williams L. A., D'Alessandro U., Weber M. M., Mulholland K., Okorie C., Langerock P., Bennett S., Greenwood B. M. Clinical predictors of malaria in Gambian children with fever or a history of fever. Trans R Soc Trop Med Hyg. 1998 May-Jun;92(3):300–304. doi: 10.1016/s0035-9203(98)91021-5. [DOI] [PubMed] [Google Scholar]
  13. Olivar M., Develoux M., Chegou Abari A., Loutan L. Presumptive diagnosis of malaria results in a significant risk of mistreatment of children in urban Sahel. Trans R Soc Trop Med Hyg. 1991 Nov-Dec;85(6):729–730. doi: 10.1016/0035-9203(91)90432-x. [DOI] [PubMed] [Google Scholar]
  14. Redd S. C., Kazembe P. N., Luby S. P., Nwanyanwu O., Hightower A. W., Ziba C., Wirima J. J., Chitsulo L., Franco C., Olivar M. Clinical algorithm for treatment of Plasmodium falciparum malaria in children. Lancet. 1996 Jan 27;347(8996):223–227. doi: 10.1016/s0140-6736(96)90404-3. [DOI] [PubMed] [Google Scholar]
  15. Rougemont A., Breslow N., Brenner E., Moret A. L., Dumbo O., Dolo A., Soula G., Perrin L. Epidemiological basis for clinical diagnosis of childhood malaria in endemic zone in West Africa. Lancet. 1991 Nov 23;338(8778):1292–1295. doi: 10.1016/0140-6736(91)92592-p. [DOI] [PubMed] [Google Scholar]
  16. Sanchez-Carrillo C. I. Bias due to conjunctiva hue and the clinical assessment of anemia. J Clin Epidemiol. 1989;42(8):751–754. doi: 10.1016/0895-4356(89)90071-1. [DOI] [PubMed] [Google Scholar]
  17. Schellenberg J. R., Smith T., Alonso P. L., Hayes R. J. What is clinical malaria? Finding case definitions for field research in highly endemic areas. Parasitol Today. 1994 Nov;10(11):439–442. doi: 10.1016/0169-4758(94)90179-1. [DOI] [PubMed] [Google Scholar]
  18. Strobach R. S., Anderson S. K., Doll D. C., Ringenberg Q. S. The value of the physical examination in the diagnosis of anemia. Correlation of the physical findings and the hemoglobin concentration. Arch Intern Med. 1988 Apr;148(4):831–832. [PubMed] [Google Scholar]
  19. Tamayo S. G., Rickman L. S., Mathews W. C., Fullerton S. C., Bartok A. E., Warner J. T., Feigal D. W., Jr, Arnstein D. G., Callandar N. S., Lyche K. D. Examiner dependence on physical diagnostic tests for the detection of splenomegaly: a prospective study with multiple observers. J Gen Intern Med. 1993 Feb;8(2):69–75. doi: 10.1007/BF02599986. [DOI] [PubMed] [Google Scholar]
  20. Weber M. W., Kellingray S. D., Palmer A., Jaffar S., Mulholland E. K., Greenwood B. M. Pallor as a clinical sign of severe anaemia in children: an investigation in the Gambia. Bull World Health Organ. 1997;75 (Suppl 1):113–118. [PMC free article] [PubMed] [Google Scholar]
  21. Wurapa F. K., Bulsara M. K., Boatin B. A. Evaluation of conjunctival pallor in the diagnosis of anaemia. J Trop Med Hyg. 1986 Feb;89(1):33–36. [PubMed] [Google Scholar]

Articles from Archives of Disease in Childhood are provided here courtesy of BMJ Publishing Group

RESOURCES