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Epidemiologic Features Impacting the Presentation of Malaria in Children in Houston

Oramasionwu, Gloria E. MD, MPH*; Wootton, Susan H. MD; Edwards, Morven S. MD*

The Pediatric Infectious Disease Journal: January 2010 - Volume 29 - Issue 1 - p 28-32
doi: 10.1097/INF.0b013e3181b34f7c
Original Studies

Background: Malaria is diagnosed in children in the United States despite availability of effective chemoprophylaxis. The features impacting the presentation of malaria diagnosed in a nonendemic setting are not well characterized in children.

Methods: A retrospective chart review was conducted of children with peripheral smear-confirmed malaria diagnosed from 1994 to 2007 at 4 tertiary referral hospitals in Houston, TX.

Results: Among 104 children with malaria, 43 were recent immigrants and 61 were travelers leaving the United States. Severe malaria accounted for 21 (20%) of episodes. Children residing in the United States accounted for 86% of those with severe malaria. Factors relating to malaria severity included vacation-related travel (P = 0.005), female gender (P = 0.02), birth in the United States (P = 0.043), short travel duration (P = 0.024), and short duration from return to presentation (P = 0.023). Children with severe malaria more often had a history of vomiting (P = 0.048) and presented with hepatomegaly (P = 0.008), heart murmur (P = 0.041), and higher parasitemia (P < 0.001) than those with uncomplicated malaria. Vacation-related travel (OR: 19.7; 95% CI: 2.2–174.6) and hepatomegaly (OR: 6.1; 95% CI: 1.1–32.8) remained significant risk factors for severity by multivariate analysis. Prophylaxis appropriate to region of travel was documented in only 8 of 47 children leaving the United States.

Conclusions: Children diagnosed in Houston with severe malaria usually had traveled from the United States to malaria-endemic regions without benefit of appropriate prophylaxis. Malaria-related morbidity in nonendemic countries could potentially be reduced by optimizing adherence to prophylactic regimens.


From the *Section of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine, Houston, TX; and †Division of Infectious Diseases, Department of Pediatrics, University of Texas Health Science Center at Houston, Houston, TX.

Accepted for publication June 17, 2009.

Dr. Edwards is a consultant for Novartis Vaccines and Diagnostics.

Address for correspondence: Morven S. Edwards, MD, Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030. E-mail:

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© 2010 Lippincott Williams & Wilkins, Inc.