LACK OF ASSOCIATION BETWEEN FALCIPARUM-MALARIA PARASITEMIA AND ACUTE DIARRHEA IN NIGERIAN CHILDREN

It is widely believed that malaria causes diarrhea. Yet, national and international diarrheal diseases control programs are silent about the overlap between these two major public health problems that coexist i n most tropical countries. To test the hypothesis that malaria is asso ciated with diarrhea and to define the role of malaria in morbidity du e to diarrhea, 522 children 6-60 months of age presenting with acute d iarrhea to the Children's Emergency Ward of the University College Hos pital in Ibadan, Nigeria were routinely screened by means of thin and thick blood films for malaria parasitemia. Controls, without diarrhea, were studied in parallel. Detailed clinical features were recorded fa r every patient, Sir;ty-eight (13%) of the 522 diarrhea patients scree ned had malaria parasitemia; Among the controls (who had similar distr ibutions of admission temperature, hemoglobin types, glucose-6-phospha te dehydrogenase deficiency, and prior treatment with antimalarial dru gs), parasitemia was not significantly different, occurring in 56 (17. 9%) of 313. In the dry season, however, a significantly higher prevale nce of parasitemia was observed among the control group (15.5%) than i n the diarrhea group (7.0%) (P = 0.004). Parasitemia was significantly more common in the dehydrated diarrhea patients than their well-hydra ted counterparts (25% of 56 versus 11% of 466; P < 0.005). There were no significant-differences in admission temperature, the presence of v omiting, or the home use of oral rehydration fluids between the dehydr ated and the well-hydrated subsets of diarrhea patients. Consideration of parasite densities did not alter any of the foregoing relationship s. These data contradict the widely held view that diarrhea is a sympt om of malaria or that malaria causes diarrhea. They do, however, provi de support for examining blood smears at least in dehydrated children with diarrhea in malaria-endemic areas and giving immediate antimalari al therapy to those who have malaria parasitemia.