Pediatrics studies

1. MALARIA IN CHILDREN

2. MALARIA
• DEFINITION
• Malaria is an acute febrile condition caused by Plasmodium parasites which
are spread to people by the bites of infected female anopheles mosquitoes
• Five species cause the disease kin humans:-
• Plasmodium falciparum
• Plasmodium malariae
• Plasmodium vivax
• Plasmodium ovale
• Plasmodium knowlex

3. EPIDEMIOLOGY
• In 2022 an estimated 249 million people contracted malaria in 85
countries. The disease claimed 608000 lives
• SUSCEPTIBILITY:
• Some people are more susceptible to develop severe malaria than
others
• Infants and children under 5 years of age
• Pregnant women
• Patients with HIV/AIDS
• People from non-malarial area entering afeas with intense malaria
transmission

4. • Sometimes the symptoms may be mild and difficult to recognize as
malaria
• UNCOMPLICATED MALARIA
• The child will present with fever, headache, malaise, fatigue, joint
pain, vomiting, diarrhoea and poor appetite. It is not uncommon for
the child to develop hepatosplenomegaly and anaemia
• N/B: an uncomplicated malaria attack can become sever malaria
• SEVERE MALARIA
• Cerebral malaria: common complication of Plasmodium falciparum
malaria. The child will present with fever, convulsions and coma

5. SEVERE MALARIA(cont)
• Severe anaemia, Hb less than 7g/dl. Probably caused by long
standing low grade parasitaemia
• HYPERPARASTAEMIA, over 250,000 parasites /mm3 or over 5000/200
white blood cells or over 5% of erythrocytes infected
• SEVERE RESPIRATORY DISTRESS, caused by pulmonary oedema or
metabolic acidosis. This predicts high mortality
• CONVULSIONS, repeated generalized convulsions more than 2 times
within 24 hours. May be the first sign of cerebral malaria
• HYPOGLCAEMIA, (blood sugaMr less than 40mg/dl or 2.6 mmol/L).
Must be treated immediately

6. MALARIA (cont)
• COMPLICATIONS:
• Acute kidney injury
• Jaundice
• Haemoglobinuria
• Disseminated intravascular coagulation
• (cont)….

7. • Those who have not acquired immunity or those not taking
chemoprophylaxis such as migrants
• Note: People in areas where malaria is common will develop partial
immunity that reduces the risk that malaria will cause severe disease
• SYMPTOMS:
• Usually begins within 10-15 days after a bite from an infected
mosquito
• -Fever
• -Headache
• -Chills

8. TREATMENT
• UNCOMPLICATED MALARIA
• First line: Artemether(20mg)-Lumefantrine (120 mg) ALU
• Dose: 1.5-12 mg/kg twice a day for three days.
• For complicated malaria, the child should be admitted

9. TREATMENT OF UNCOMPLICATED MALARIA
WT (kg) AGE DAY 1 DAY 2 DAY 3
0 hr 8hrs morning evening morning evening
5-15 3mo-3yrs 1 1 1 1 1 1
15-25 3-8yrs 2 2 2 2 2 2
25-35 8-12yrs 3 3 3 3 3 3
Above
35
Above 12 4 4 4 4 4 4

10. • Contraindications- Child less than 5 kg or less than 3months don’t
give ALU, give quinine instead
• Second line treatment is:
• Dihydroartemisinin and piperaquine
• ALL CASES OF SEVERE MALARIA SHOULD BE REFERRED FOR
ADMISSION