Volume 83, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Severe malaria in adults has been reported from Bikaner (northwestern India) but the reports on children are scanty. This prospective study was done on 303 admitted children of malaria. The diagnosis was done by peripheral blood smear and rapid diagnostic test. Further confirmation of severe monoinfection was done by polymerase chain reaction (PCR). The proportion of , , and mixed ( and ) infection was 61.01%, 33.99%, and 4.95%, respectively. Severe disease was present in 49.5% (150/303) children with malaria, with the risk greatest among monoinfection (63.1% [65/103]) compared with , either alone (42.7% [79/185]; odds ratio [OR] = 2.3 [95% confidence interval (CI) = 1.40–3.76], = 0.001) or mixed infections (40% [6/15]; OR = 2.57 [95% CI = 0.88–7.48]). In children < 5 years of age, the proportion of severe malaria attributable to rose to 67.4% (31/46) compared with 30.4% (14/46) of (OR = 4.7 [95% CI = 2.6–8.6], < 0.0001) and 2.2% (1/46) of mixed infection (OR = 92 [95% CI = 24.6–339.9], < 0.0001). The proportion of patients having severe manifestations, which included severe anemia, thrombocytopenia, cerebral malaria, acute respiratory distress syndrome, hepatic dysfunction, renal dysfunction, abnormal bleeding was significantly high in association with monoinfection in 0–5 year age group, while the same was significantly high in association with monoinfection in 5–10 year age group. Similarly monoinfection had greatest propensity to cause multiorgan dysfunction in 0–5 year age group (34.1% [17/41], < 0.0001) in comparison to monoinfection, which had similar propensity in 5–10 year age group (36.8% [35/95], = 0.039). monoinfection was almost equally serious to cause significant mortality in comparison to (case fatality rate of severe was 3.9% versus 3.2% of severe malaria; = 1.0). This study reaffirms the evidence of severe malaria in children in Bikaner.


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  • Received : 20 Oct 2009
  • Accepted : 23 Jul 2010
  • Published online : 05 Nov 2010

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