Malaria parasitemia among febrile children in western Kenya: Clinicaapproach, clinical characteristics and haematological indices in the context of their HIV status

Abstract

Fever is a common reason why children are brought to a health facility. The cause of fever in children in resource-limited settings is rarely investigated and thus clinical characteristics are relied on to make presumptive diagnosis especially for malaria. Although WHO emphasises on confirmatory diagnosis and provides guidelines on the approach of a febrile child in a malaria endemic region, it does not specifically guide on the management of febrile HIV infected children in malaria endemic regions. In these areas, where there is high malaria morbidity and mortality, use of cotrimoxazole is the standard of care among the HIV infected children. This cross sectional descriptive study aimed at determining the prevalence of malaria parasitemia among febrile children and describing their clinical and haematological characteristics in the context of their HIV status. The results indicate that frequency of presumptive diagnosis among febrile children (50%) is high among the clinicians. The prevalence of malaria parasitemia is 51.2% and 84% among non-HIV infected and the HIV infected febrile children respectively. Of the HIV infected, 97% were on cotrimoxazole. The non-HIV infected group were more likely to present typically for malaria and to use malaria preventive measures such as bed nets (P-value˂ 0.001). Splenomegaly, hepatomegaly and anaemia were significantly higher in the HIV infected malaria parasitemic children (p-value ≤0.001). However, these HIV infected febrile children had generally more favourable haematological parameters (haemoglobin & MCV) compared to the HIV non infected (p-value≤0.0001).Vomiting, chills and convulsions were found to independently predict malaria parasitemia (OR, CI 95%) 1.74(91.04, 2.91); 3.17(1.55, 6.48); 3.49 (1.168, 10.417) respectively among the HIV non-infected, while age and WBC count were predictors of parasitemia among the HIV infected OR (95%CI) 0.983 (0.972, 0.994); 0.9345 (0.886, 0.986), respectively. In conclusion, malaria prevalence is still high in western Kenya, confounded by the HIV pandemic and it is clear that many febrile children are managed presumptively for malaria, despite availability of reliable laboratory services and the WHO guidelines. In addition in respect to malaria parasitemia prevalence there is an apparent age shift towards the older children. It’s worth noting that Chloroquine and Sulfadoxin/pyrimethamine are still being obtained over the counter in this community and more so by the HIV non- infected population. Furthermore, malaria prevalence is higher in the HIV infected group despite the use of cotrimoxazole prophylaxis. Higher utilisation of laboratory testing for malaria as well as anti- folate resistance testing is recommended while an alternative prophylaxis is sought that prevents malaria as well.