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.
