ABSENCE OF MALARIA-SPECIFIC MORTALITY IN CHILDREN IN AN AREA OF HYPERENDEMIC MALARIA

We conducted a prospective community-based malaria surveillance study on a cohort of children <10 years old living in an area of hyperendemi c malaria (spleen rates >50% in children aged 2-9 years) in Vanuatu, M elanesia, supported by a concurrent prospective descriptive study of m alaria admissions to the local hospital. The incidence of clinical mal aria in children <10 years old was 1.9 episodes/year. The annual incid ence of severe malaria (severe malarial anaemia and cerebral malaria) was only 2/1000 in children aged <5 years. The only manifestation of s evere malaria seen in indigenous children was anaemia. No death could be attributed to malaria. While the incidence of uncomplicated clinica l malaria in this population was comparable to that in many parts of A frica, the incidence of severe forms of the disease was significantly lower. This could not be attributed to differing rates of malaria tran smission, chloroquine resistance, or to host protective or behavioural factors. These findings suggest that studies which compare disease pa tterns in geographically disparate populations may be instrumental in developing a better understanding of the determinants of clinical outc ome in Plasmodium falciparum malaria and that such regional difference s must be considered when planning or interpreting the effects of mala ria interventions.