Fever Cases Associated with Plasmodium falciparum Malaria Infection among Children Attending a Tertiary Health Facility in Imo State, Nigeria

Main Article Content

C. I. Okoro
F. C. Ihenetu
K. E. Dunga
K. Achigbu
C. C. Obasi
K. K. Odinaka
E. S. Anikwo

Abstract

Background: Malaria is a major cause of fever in endemic countries, although the prevalence of malaria has been declining across Sub-Saharan Africa, the proportion of clinical presentation attributable to febrile illness due to malaria to febrile illnesses have remained high. It is therefore important to determine the proportion of fever cases attributable to malaria.

Methods: A descriptive cross sectional study was conducted among children aged 1-72 months presenting at a tertiary facility in Imo state Nigeria from 1st March, 2014 to 31st October, 2015.

Children between 1-72 months of age with documented fever at presentation or history of fever in the last 24 hours without signs of severe malaria and those without any history of anti-malarial drugs administration were considered eligible. Fever was regarded as axillary temperature of ≥37.5°C. For all subjects (febrile and afebrile), the presence of Plasmodium falciparum was assessed microscopically by a WHO Certified malaria microscopist. Malaria parasite density was grouped as 1-1000, 1001–10000, and >10,000 parasites/µl respectively according to World Health Organization guidelines for grouping malaria parasitamae while data was analysed using SPSS 20.1v.

Results: Overall malaria prevalence of both febrile and afebrile at point of assessment but with history of fever in the last 24 hours was 24.3%. Prevalence by microscopy was 26% among the 289 children who were febrile as at point of examination. There was no significant difference (p>0.05) between malaria prevalence in males as against females.

Age group 49-72 months had the highest prevalence (42.6%), while age groups 25-48 and 1-24 months recorded prevalence of 35.7% and 25%, respectively (P<0.05). About 22.5% of afebrile patients had positive Plasmodium parasitaemia. The Geo-mean (range) of parasitaemia was 1427(8-180,000) parasite/µl while mean body temperature ± SD was 37.0±0.9°C. About 8% of the children had high parasite density.

Conclusion: Plasmodium falciparum although linked with majority of fever is not the cause of fever in all instances. Healthcare providers should make more effort to correctly diagnose non-malaria febrile cases so as to optimize clinical outcomes for the patients and minimize possible over diagnosis and overtreatment of malaria.

Keywords:
Plasmodium falciparum, fever, afebrile, febrile, malaria, children

Article Details

How to Cite
Okoro, C. I., Ihenetu, F. C., Dunga, K. E., Achigbu, K., Obasi, C. C., Odinaka, K. K., & Anikwo, E. S. (2020). Fever Cases Associated with Plasmodium falciparum Malaria Infection among Children Attending a Tertiary Health Facility in Imo State, Nigeria. International Journal of TROPICAL DISEASE & Health, 41(5), 7-14. https://doi.org/10.9734/ijtdh/2020/v41i530274
Section
Original Research Article

References

Nigeria Malaria Indicator Survey (NMIS). Individual and household-level determinants of malaria infection in under-5 children from north-west and southern Nigeria: A cross-sectional comparative study based on the 2015 Nigeria Malaria Indicator Survey; 2015.

World Health Organisation. World Malaria Report 2017. World Health Organization, Geneva, Switzerland; 2017.

Lokeshwar N. Febrile neutropenia in haematological malignancies. J. Postgrad Med. 2000;45:4-12.

Winstanley M, Marsh V, Newton C, Winstanley P, Warn P, Peshu N, Pasvol G, Snow R. Indicators of life-threatening malaria in African children. N. Eng. J. of Med. 2004;332:1399–1404.

Theresa TE, Kwenti TDB, Latz A, Njunda LA, Nkuo-Akenji T. Epidemiological and clinical profile of paediatric malaria: a cross sectional study performed on febrile children in five epidemiological strata of malaria in Cameroon. BMC Inf. Dis. 2005; 17:499.

Winters RA, Murray HW. Malaria: The mime revisited: Fifteen more years of experience at a New York City teaching hospital. Am J Med. 1992;93:243-6.

Suh KN, Kain KC, Keystone JS. Malaria. Canad. Med Asso. J. 2004;170(11):1693-1702.

Runsewe-Abiodun IT, Ogunfowora OB, Fetuga BM. Neonatal malaria in Nigeria— a 2 year review. BMC Peds; 2006.

Karunaweera Y. Parallel between body temperature and TNF levels during the period of chill in patients with p. vivax infections in Sri Lanka. Pro. Natl. Acad. Sci. USA. 1992;89:3200-3202.

Emilo VP, Thomas E. Paediatric malaria; 2005.
[Cited on 2010 November]
Available:http://emedicine.medscape.com/article/221134-malaria overview

World Health Organisation. Handbook IMCI. Integrated Management of Childhood Illness. Geneva: World Health Organization; 2005.

Olaleye BO, William LA, D’Alessandro U, Langerock Webe MM. Clinical predictors of malaria in Gambian children with fever or a history of fever. Trans R Soc Trop Med Hyg. 1988;92:300-304.

Ikeh EI, Teclaire NN. Prevalence of malaria associated factors in febrile under- 5 children seen in primary health care centers in jos, North Central Nigeria. Nig. Post. Med. J. 2000;15(2):65-69.

D’Acremont V, Lengeler C, Genton B. Reduction in the proportion of fevers associated with plasmodium parasitaemia in Africa: a systemic review. Mal. J. 2010;9(10):240.

Ama EM. Handbook on Owerri Metropolis. Owerri, Hoodwell Publishers; 2003.

WHO. World Health Organization Training of Malaria Microscopists by WHO/AMREF in Nairobi Kenya; 2012.

WHO; 2020.
http://www.who.int/malaria

Cheesbrough M. District Laboratory Practice Manual in Tropical Countries pt. 2 Cambridge University Press; 2006.

Ekpenyong EA, Eyo JE. Malaria control and treatment strategies among school children in semi-urban tropical communities. W. Ind. Med. J. 2008;57(5): 456–461.

Opara KN, Atting IA, Ukpong IG, Nwabueze AA, Inokon II. Susceptibility of genetic Indices to Falciparum Malaria in Infants and Young Children in Southern Nigeria. Pak. J. Biol. Sci. 2006;9:452- 456.

Nwolisa CE, Erinugha AU, Ofoleta SI. Pattern of morbidity among pre-school children attending the children’s outpatient clinic of Federal Medical Centre, Owerri, Nigeria. Nig. J Med. 2015;14(4):378-380.

Iloh GUP, Orji U, Amadi AN. Malaria Morbidity among Under-Five Nigerian Children: A study of its prevalence and Health Practices of Primary Care Givers (Mothers) in a Resource-Poor Setting of a Rural Hospital in Eastern Nigeria. Eur. J. Pre. Med. 2013;1(3):50-57.

Okiro EA, Gething PW, Patil AP, Tatem AJ, Guerra CA. Estimating the Global Clinical Burden of Plasmodium falciparum Malaria in 2007. PLoS Med. 2010;7(6): e1000290.

Okoro CI, Chukwuocha UM, Nwakwuo GC, Ukaga CN. Presumptive diagnosis and treatment of Malaria in Febrile Children in Parts of South Eastern Nigeria. J Infect Dis Ther. 2015;3:240.

Okafor HU, Oguonu T. Epidemiology of malaria in infancy at Enugu, Nigeria. See comment in PubMed Commons below Niger J ClinPract. 2006;9:14-17.

Chukwuocha U. Rapid assessment of home management of malaria among caregivers in parts of south eastern Nigeria. Pan Afr Med J. 2011;10:29.

Anumudu CI, Okafor CMF, Ngwumohaike V, Afolabi KA, Nwuba RI, Nwagwu M. Epidemiological factors that promote the development of severe malaria anaemia in children in Ibadan. Afr Health Sci. 2007;7: 80- 85.

Schofield J, Grau GE. Immunological processes in malaria pathogenesis. Nature Immunology. 2005;5:722-735.

Iriemenam NC, Okafor CMF, Balogun HA, Ayede I, Omosun Y, Persson J. Cytokine profiles and antibody responses to Plasmodium falciparum malaria infection in individuals living in Ibadan, south-west Nigeria. Afr. H. Sci. 2009;9(2):66-74.