BackgroundInfection by Plasmodium vivax has been considered rarely threatening to life, but recent studies challenge this notion. This study documented the frequency and character of severe illness in paediatric patients admitted to a hospital in south-eastern Pakistan with a laboratory-confirmed diagnosis of vivax malaria.MethodsAn observational study of all 180 paediatric patients admitted with any diagnosis of malaria during 2010 was conducted: 128 P. vivax; 48 Plasmodium falciparum; and four mixed infections of these species. Patients were classified as having severe illness with any of the following indicators: Glascow coma scale <11; ≥2 convulsions; haemoglobin <5g/dL; thrombocytes <50,000/mL; blood glucose <45mg%; >70 breaths/min; or intravenous anti-malarial therapy. Additionally, 64 patients with a diagnosis of vivax malaria were treated during 2009, and the 21 of these having severe illness were included in analyses of the frequency and character of severe illness with that diagnosis.ResultsDuring 2010, 39 (31%) or 37 (77%) patients with a diagnosis of P. vivax or P. falciparum were classified as having severe disease. Including the 2009 records of 64 patients having vivax malaria, a total of 60 (31%) patients with severe illness and a diagnosis of P. vivax were available. Altered mental status (Glascow coma scale score <11; or ≥2 convulsions) dominated at 54% of the 83 indicators of severe illness manifest among the patients with vivax malaria, as was true among the 37 children with a diagnosis of falciparum malaria and being severely ill; 58% of the 72 indicators of severe disease documented among them. No statistically significant difference appeared in frequencies of any other severe disease indicators between patients diagnosed with vivax or falciparum malaria. Despite such similarities, a diagnosis of falciparum malaria nonetheless came with 3.8-fold (95% CI = 1.8-8.1) higher risk of presenting with severe illness, and 8.0-fold (95% CI = 2.1-31) greater likelihood of presenting with three or more severe disease indicators. Two patients did not survive hospitalization, one each with a diagnosis of falciparum or vivax malaria.ConclusionsVivax malaria caused a substantial burden of potentially life-threatening morbidity on a paediatric ward in a hospital in south-eastern Pakistan.

Objectives: To assess the validity /strength of clinical diagnosis of Malaria on the basis of IMNCI algorithm by slide microscopy (gold standard) and to compare the effectiveness of Rapid Diagnostic Test (RDT )against slide microscopy. Methods : It is a descriptive cross sectional study of 6 month duration conducted at Pediatric Outpatient Department LUH Hyderabad from June-Dec. 2010. Sample of 400{the minimum required sample was 385 with malaria prevalence 5% (0.05) with margin of error of 3% (0.03, frequency vary from 2—8 % among different studies)} febrile children under 5 years classified as Suspected Clinical Malaria according to algorithm of IMNCI were included; The operational definition for Suspected Clinical Malaria was; fever for more than 2 days with no runny nose, no measel rash and no other cause of fever. Hyderabad was considered as low risk area. Rapid diagnostic test (RDT) and slide microscopy were done, and only confirmed cases were treated according to current guidelines given by National Malaria Program/updated IMNCI. Results: Total 2000 patients under 5 years presented with fever and were evaluated. From 2000 cases 20% (400) were diagnosed as suspected clinical Malaria according to IMNCI algorithm; and only 40 cases (10%) have shown positive results for malaria parasite on slide microscopy and 38 cases on RDT. Regarding the plasmodium species 70% were vivax and 30% were falciparum. As regards the effectiveness, RDT has shown 95% sensitivity for the detection of plasmodium antigens in the febrile clinically suspected cases of malaria. Conclusion: Prompt and accurate diagnosis of malaria is needed for implementation of appropriate treatment to reduce unnecessary anti-malarial prescription. RDT is as effective as slide microscopy for the diagnosis of malaria especially in resource poor countries.

Objectives: To assess the Nutritional Status by measuring Body Mass Index and screening of School going children of Khairpur Mirus Sindh. Study Design: Cross Sectional Descriptive Study. Setting: Department of Pediatrics, Liaquat University of Medical and Health Sciences Jamshoro. Period: From 1st May to 31st May 2015. Material & Methods: Over 2400 children (age 5 to 18 years) studying at schools of Taluka Khairpur Mirus, Sindh. We conducted this study at 40 schools, both from government and private sector. Schools included Primary, Secondary, High and Higher Secondary Schools. Medical History was taken and detailed physical examination done, including Cardiovascular Examination, Eye and Abdominal Examination. History of presence of worms in stool was taken from children. Anemia was checked by palmer inspection. Weight and height was taken by well-trained doctors and paramedical staffs with the help of weight machine and stadiometer. Results: Out of total 2400 children 43.4% were male and 56.6% were female. Mean BMI was 15.97, while mean weight was 30.93 kg and mean height was 136.92 cm. Among 730 children, who were underweight, 54.5% children were mild underweight, while 29.7% children were moderate underweight and 15.7% children were severe underweight. 6% children were overweight, while 4% children were obese. Anemia was present in 63.04% children, Eye Squint was present in 3.1% children, worms infestations were present in 0.2% children and murmur was detected in 0.1% children. Conclusion: We found significant number of children having low BMI (30.4%) and the Mean BMI was 15.97. We also found significant number of children having underweight that is 54.5% children were mild underweight, while 29.7% children were moderate underweight and 15.7% children were severe underweight. On the other hand, overweight and obesity was less common, 6% children were overweight, while 4% children were obese. During Screening, Anemia was (63.04%) and Eye Squint (3.1%) was the most common clinical findings.