Body temperature is a poor predictor of malaria parasitaemia in children with acute diarrhoea.

In order to ascertain the usefulness of a temperature > or = 38 degrees C or a history of fever in detecting malaria parasitaemia in children with diarrhoea as recommended by the World Health Organization (WHO), 522 children aged from 6 to 60 months presenting with acute diarrhoea were studied in Ibadan, Nigeria. The overall prevalence of malaria parasitaemia was 13%. There was no significant difference in the prevalence of parasitaemia between patients with a temperature > or = 38 degrees C and those < 38 degrees C. Neither was any difference found in the prevalence of parasitaemia between those with and those without a history of fever. Temperature > or = 38 degrees C had a low sensitivity (53%) and specificity (57%) and a low positive predictive value (16%) in detecting malaria parasitaemia. A history of fever had a higher sensitivity (79%) than temperature > or = 38 degrees C in detecting malaria parasitaemia but a low specificity (27%) and low positive predictive value (14%). Similar results were obtained in a simultaneously studied non-diarrhoea control group of 313 children. The implications of using the current WHO guidelines is that many diarrhoea patients with malaria would not be identified, while many patients without malaria would be treated unnecessarily. The latter situation may be associated with the development of drug-resistant malaria parasites while the children are unnecessarily exposed to the risk of drug-related complications. It is recommended that while the search for better guidelines continues children should be screened for malaria parasitaemia before treatment, where facilities are available.

Duke Scholars

Author Rasheed Adebayo Gbadegesin Pediatrics, Nephrology