OVERLAP IN THE CLINICAL-FEATURES OF PNEUMONIA AND MALARIA IN AFRICAN CHILDREN

Pneumonia and malaria are common causes of childhood morbidity and mor tality in many developing countries and simple guidelines have been pr oposed to facilitate their diagnosis by relatively unskilled health wo rkers. We have studied children in The Gambia attending out-patient an d under-five clinics with clinically suspected pneumonia (cough or dif ficulty in breathing and a raised respiratory rate) during periods of high or low malaria transmission. During a period of high malaria tran smission, 33% of these children had radiological evidence of pneumonia (with or without malaria parasitaemia) compared to 38% who had malari a parasitaemia, no radiological evidence of pneumonia and no other obv ious cause of fever. Corresponding figures during a period of low mala ria transmission were 48% and 6% respectively. The clinical overlap be tween pneumonia and malaria has important implications for case manage ment strategies and evaluation of disease-specific interventions in re gions in which both pneumonia and malaria are prevalent.