Cerebral malaria in Malawian children hospitalized with Plasmodium falciparum infection

A hospital-based, prospective study was undertaken at Mangochi District Hos pital (MDH) and Kamuzu Central Hospital (KCH) in Malawi. The malaria-transm ission patterns in the catchment areas of these two hospitals are very diff erent, transmission being continuous around MDH and seasonal, occurring mos tly during the rainy season, around KCH. The main purpose of the study was to determine and compare the prevalences of cerebral malaria (CM) among you ng, hospitalized children (aged < 5 years) at both sites. Among 8600 of suc h children admitted to the two hospitals, the overall prevalence of CM was 2.3% (2.2% at KCH and 2.5% at MDH). The prevalences of Chi on admission wer e similar at the two sites during the rainy season (at 3.2%), but the preva lence at MDH during the dry season was statistically higher than that at KC H over the same period (2.1% v. 1.0%; P = 0.0078). A nearly significant dif ference was noted between the two sites in the prevalences of parasitaemia on admission (11.9% at KCH v. 9.2% at MDH; P = 0.07), and of severe malaria l anaemia (SMA) on admission (5.4% at KCH v. 4.2% at MDH; P = 0.06). No int er-site differences were noted in the prevalences of Chi or SMA when analys ed by mean age, weight, haemoglobin, body temperature, weight-for-age Z-sco res, duration of hospitalization, or proportion with high parasite score on admission. These findings differ from those by researchers in other parts of sub-Saharan Africa, where the prevalence of CM has been found to be high er in areas with seasonal transmission patterns. It appears that the epidem iology of CM can differ within the same country, with location and season. Whenever possible, therefore, plans to control CM in any sub-Saharan countr y should be based on locally generated data.