Simple clinical parameters to diagnose Malaria in Outpatient Department.

Introduction: Malaria is the world's most important parasitic infection which poses major health challenges. Best estimates currently describe the annual global burden of malaria as 300-500 million cases and 1-2 million deaths. Traditionally malaria is diagnosed clinically based upon sign symptoms and clinical examination particularly in remote areas where laboratory facilities are not available. However, no universal criteria exist for clinical diagnosis of malaria and presenting features are highly variable region to region. Therefore, we planned to define the simple parameters based on clinical signs and symptoms that predict malaria without laboratory confirmation of parasitemia. Objective: To determine the sensitivity, specificity and positive predictive values of simple clinical parameters for the diagnosis of malaria without laboratory confirmation of parasitemia. Methodology: This observational study was carried out at pediatric department of Karachi Medical and Dental college and Abassi Shaheed Hospital Karachi during 15 April 2015 to 15 February 2015. Children between 6 months to 5 years, who presented with short duration of fever (less than 7 days) were included in study. The diagnosis of malaria was confirmed on identification of parasite (Plasmodium vivax or Plasmodium falciparum) in blood obtained from finger prick sample for thick and thin film. The patients were divided into two groups (+ve MP cases and -ve MP cases). Focal signs and symptoms, pallor (anemia) and splenomegaly were checked in both groups to assess the sensitivity, specificity and predictive values of these simple clinical parameters and co-related with the presence of malaria parasitemia. Result: Six hundred fifty-seven children were examined. One hundred (15.22%) children out of 657 had malaria confirmed while 84.78% (557 of 657) had illness other than malaria. There were 43 children (43%) with Plasmodium falciparum malaria, 47 children (47%) with Plasmodium vivax malaria and 10 (10%) with mixed infections. Three clinical parameters (No focal features, anemia & splenomegaly) were studied in all febrile patients which were divided into two groups (Malarial parasite +ve and malarial parasite -ve). Conclusion: Few simple clinical findings can lead to reliable clinical diagnosis of malaria with more logical use of antimalarial drugs in children.  Key words: Malaria, Anemia, Splenomegaly.