SEVERE MALARIA AMONG CHILDREN IN A LOW SEASONAL TRANSMISSION AREA, DAKAR, SENEGAL - INFLUENCE OF AGE ON CLINICAL PRESENTATION

The influence of age on the clinical presentation of severe malaria an d especially on its 2 most commonly encountered manifestations, cerebr al malaria and severe anaemia, has been retrospectively examined in 16 1 children (<16 years old) admitted to the paediatric department of Ho pital Principal de Dakar from 1 January 1990 to 29 February 1996. They lived in Dakar and its suburbs, a region of Senegal where the malaria transmission rate is very low Cases were defined by at least one of t he World Health Organization criteria of severe malaria and the presen ce of Plasmodium falciparum in blood smears. Severe anaemia was presen t in 73.1%, 52.1% and 26.2% cases of severe malaria among children age d 0-3 years, 4-7 years and 8-15 years, respectively (P<0.0001). The fr equency of cerebral malaria was 11.3%, 28.2% and 60.6%, respectively, in the same age groups (P<0.0001). Severe anaemia and cerebral malaria were associated in 8.7% of the cases of severe malaria. The fatality rate was significantly lower in cases of severe anaemia without cerebr al malaria (3%) than in cases of cerebral malaria without severe anaem ia (17.5%; P<0.02). Among young children, severe anaemia was associate d with brief hyperparasitaemia or with prolonged lower parasitaemia. O ther things bring equal, older children had a lower risk of severe ana emia. The results suggest that the high prevalence of severe anaemia i n young children, even in an area of very low endemicity, depends more on age and parasitaemia than on the transmission level.