Clinical diagnosis of Plasmodium falciparum among children with history of fever, Sindh, Pakistan

Objective: To identify clinical predictors for malaria and develop a clinical algorithm to more accurately identify malaria from non-malaria cases.Methods: Four hundred thirty eight children aged 6-120 months attending the rural health center between August 15 and October 5, 1997, in Jhangara town of district Dadu, Sindh were recruited. A standard questionnaire was used to record symptoms and duration of child\u27s illness. Each child was physically examined, had their axillary temperature measured, and blood samples were collected from which Giemsa stained thick and thin blood films were prepared and examined for presence of Plasmodium parasites. The sensitivity and specificity of several candidate algorithms for parasitemia were evaluated using various combinations of identified predictors.Results: Twenty-six of 438 children (6%) were slide positive for malaria. An algorithm comprised of fever 3 days duration and (absence of cough or having rigors) had 100% sensitivity and 63% specificity for detecting P. falciparum.CONCLUSION: In this low malaria prevalence region, restricting the diagnosis of malaria to persons who had \u3e3 days of fever and absence of cough or rigors, remained highly sensitive but was more specific than current practice. If validated prospectively, this algorithm could reduce misdiagnosis and mis-treatment

Prevalence and predictors of malaria among febrile children attending the rural health center Jhangara in Sindh

Prevalence and Clinical Predictors for Malaria among Children of 0.5 to 10 years of age in Jhangara, Dadu, Sindh In rural Sindh, all children with fever or history of fever are considered to have malaria, and thus many undergo unnecessary anti-malarial treatment with risk of side effects and in addition other diagnoses would not be fully considered. This study was conducted to estimate prevalence of malaria and develop a clinical algorithm to more accurately identify malaria from non-malaria cases. Four hundred thirty eight children age 0.5 to 10 years attending the rural health center in Jhangara, district Dadu, Sindh were recruited. A Sindhi-translated standard questionnaire was used to record symptoms and duration of child\u27s illness. Each child was physically examined, had their axillary temperature measured, and blood samples were collected from which Giemsa stained thick and thin blood films were prepared and examined for presence of Plasmodium parasites. Multiple logistic regression was used to identify the significant predictors of a plasmodium positive blood slide for all study subjects and then for the children aged 24 months or more. The sensitivity and specificity of several candidate algorithms for parasitaemia were evaluated using various combinations have identified predictors. Of 438 children, 26 (5.9%) were Plasmodium slide positive 17 (4%) had P. falciparum. and 9 (2%) had P. vivax. Among the P. falciparum positive children, 15 (887o) had mild, and 2 (127o) had moderate density of the parasite. For children aged 24 months or more fever \u3e 3 days [adjusted odds ratio (aOR) = 5.0; 95Vo confidence interval (CI) =1.2, 26.0), rigors (aOR = 9.0; 95% CI= 3.0, 22.0) and headache (aOR =2.0, 95% CI = 0.9, 6.0), were independent predictors for a plasmodium positive blood slide. The developed clinical algorithm using the above variables had 100% sensitivity and 28% specificity. Similarly, for all study subjects; duration of fever \u3e 3 days (aOR = 2.0; 95% CI =1 .2, 26.0), and pallor (aOR = 1.3; 95% CI= 7.0, 3.70) were independent predictors for a plasmodium positive blood slide. The clinical algorithm combining these variables for all study subject was 85% sensitive and 31% specific. We developed alternative malaria case definitions that remained highly sensitive but were somewhat more specific in low endemic areas. If validated prospectively, these algorithms could prevent over-treatment in addition, it would encourage a more complete evaluation of a sick child\u27s illness

Factors associated with elevated blood lead concentrations in children in Karachi, Pakistan

OBJECTIVES: To confirm whether blood lead concentrations in Karachi were as high as reported in 1989 and to identify which types of exposure to lead contribute most to elevated blood lead concentrations in children in Karachi. METHODS: A total of 430 children aged 36-60 months were selected through a geographically stratified design from the city centre, two suburbs, a rural community and an island situated within the harbour at Karachi. Blood samples were collected from children and a pretested questionnaire was administered to assess the effect of various types of exposure. Cooked food, drinking-water and house dust samples were collected from households. FINDINGS: About 80% of children had blood lead concentrations 10 µg/dl, with an overall mean of 15.6 µg/dl. At the 5% level of significance, houses nearer to the main intersection in the city centre, application of surma to children's eyes, father's exposure to lead at workplace, parents' illiteracy and child's habit of hand- to-mouth activity were among variables associated with elevated lead concentrations in blood. CONCLUSION: These findings are of public health concern, as most children in Karachi are likely to suffer some degree of intellectual impairment as a result of environmental lead exposure. We believe that there is enough evidence of the continuing problem of lead in petrol to prompt the petroleum industry to take action. The evidence also shows the need for appropriate interventions in reducing the burden due to other factors associated with this toxic element

Elevated blood lead levels among children living in a fishing community, Karachi, Pakistan

Lead is a widespread environmental contaminant worldwide and is associated with adverse outcomes in children, including impaired neurobehavioral development and learning difficulties. A cross-sectional survey of 53 young children was conducted in a fishing village on an island adjacent to Karachi, Pakistan. Whole blood from each individual was tested for lead levels. Also tested were samples of cooked food, house dust, and drinking water from 36 households. Laboratory determinations were made by the Pakistan Council for Scientific and Industrial Research with quality control by the United States Centers for Disease Control and Prevention. Fifty-two subjects (98%) had blood lead levels above 10 microg/dl (mean 21.60 microg/dl), an internationally recognized threshold for potential neurotoxicity. The mean concentration was 3.90 microg/g in cooked food, 4.02 microg/l in drinking water, and 91.30 microg/g in house dust. These findings indicate possible major health concerns and suggest significant environmental contamination in this community as well as the need to identify locally relevant early childhood exposures

Factors associated with elevated blood lead concentrations in children in Karachi, Pakistan.

OBJECTIVES: To confirm whether blood lead concentrations in Karachi were as high as reported in 1989 and to identify which types of exposure to lead contribute most to elevated blood lead concentrations in children in Karachi. METHODS: A total of 430 children aged 36-60 months were selected through a geographically stratified design from the city centre, two suburbs, a rural community and an island situated within the harbour at Karachi. Blood samples were collected from children and a pretested questionnaire was administered to assess the effect of various types of exposure. Cooked food, drinking-water and house dust samples were collected from households. FINDINGS: About 80% of children had blood lead concentrations 10 g/dl, with an overall mean of 15.6 g/dl. At the 5% level of significance, houses nearer to the main intersection in the city centre, application of surma to children's eyes, father's exposure to lead at workplace, parents' illiteracy and child's habit of hand- to-mouth activity were among variables associated with elevated lead concentrations in blood. CONCLUSION: These findings are of public health concern, as most children in Karachi are likely to suffer some degree of intellectual impairment as a result of environmental lead exposure. We believe that there is enough evidence of the continuing problem of lead in petrol to prompt the petroleum industry to take action. The evidence also shows the need for appropriate interventions in reducing the burden due to other factors associated with this toxic element