BODY-TEMPERATURE IS A POOR PREDICTOR OF MALARIA PARASITEMIA IN CHILDREN WITH ACUTE DIARRHEA

In order to ascertain the usefulness of a temperature greater than or equal to 38 degrees C or a history of fever in detecting malaria paras itaemia in children with diarrhoea as recommended by the World Health Organization (WHO), 522 children aged from 6 to 60 months presenting w ith acute diarrhoea were studied in Ibadan, Nigeria. The overall preva lence of malaria parasitaemia was 13%. There was no significant differ ence in the prevalence of parasitaemia between patients with a tempera ture greater than or equal to 38 degrees C and those < 38 degrees C. N either was any difference found in the prevalence of parasitaemia betw een those with and those without a history of fever. Temperature great er than or equal to 38 degrees C had a low sensitivity (53%) and speci ficity (57%) and a low positive predictive value (16%) in detecting ma laria parasitaemia. A history of fever had a higher sensitivity (79%) than temperature greater than or equal to 38 degrees C in detecting ma laria parasitaemia but a low specificity (27%) and low positive predic tive value (14%). Similar results were obtained in a simultaneously st udied 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 ch ildren are unnecessarily exposed to the risk of drug-related complicat ions. It is recommended that while the search for better guidelines co ntinues children should be screened for malaria parasitaemia before tr eatment, where facilities are available.