Malaria in pregnancy: clinical features and outcome of treatment

Over two consecutive malaria seasons in 1987 and 1988, 37 patients were admitted to the Gonder College Hospital with malaria in pregnancy. In 10 patients the diagnosis was missed initially and delayed for up to 72 hours after admission. The differential diagnoses considered on first line included incomplete abortion, labour, postpartum haemorrhage, and fulminant hepatitis in pregnancy. Twelve patients (32.4%) died, five of these died undelivered. Fifteen pregnancies (40.5%) ended up in abortion, preterm delivery with early neonatal death and still birth. This study has shown that malaria in pregnancy can have different clinical manifestations that may mislead the physician. This may delay the diagnosis and initiation of treatment which may have a fatal outcome for both the mother and the baby.     

Malaria in Nottingham children

In five and a half years 16 children were admitted to hospital in Nottingham suffering from malaria. Thirteen cases were caused by Plasmodium vivax and two by P falciparum, and in one the type was not identified. All were children of immigrant parents, predominantly from Pakistan, although most were born in England but had been visiting Asia. Three children were ill on or soon after arrival, but in the others the onset of symptoms was delayed by up to nine months. All made an uneventful recovery, although two children with P vivax infections had a further relapse after chloroquine treatment only. The question "Where have you been?" should be put to all immigrant parents whose children have a febrile illness. Agencies who provide travel for Asian immigrant families returning home for a visit should be encouraged to provide instructions about malaria prophylaxis.     

Malaria vaccines in development

The recent infusion of public and private funding for malaria vaccine development has greatly accelerated the pace at which candidate malaria vaccines are entering the clinic. Recent promising results from vaccine trials carried out in malaria-naive and -endemic populations have revealed important insights into what will be required of a successful vaccine. Significant challenges lie ahead, not the least of which is insuring access of a malaria vaccine to the populations that need it most. Creative strategies, strong partnerships with developing countries, industry-like approaches to product development, and political vision and leadership on the part of wealthy nations will be critical to the successful implementation of this important new tool to reduce the intolerable burden of malaria.     

Malaria vaccines in development

The recent infusion of public and private funding for malaria vaccine development has greatly accelerated the pace at which candidate malaria vaccines are entering the clinic. Recent promising results from vaccine trials carried out in malaria-naive and -endemic populations have revealed important insights into what will be required of a successful vaccine. Significant challenges lie ahead, not the least of which is insuring access of a malaria vaccine to the populations that need it most. Creative strategies, strong partnerships with developing countries, industry-like approaches to product development, and political vision and leadership on the part of wealthy nations will be critical to the successful implementation of this important new tool to reduce the intolerable burden of malaria.     

Epidemiology of Malaria in Thailand

Background : In spite of significant achievements in malaria control in the past two decades, about 150,000 malaria cases still occur in Thailand each year. Although most short-term visitors to Thailand stay in malaria-free areas, an increasing number of more adventurous travelers are exposed to the disease.
Method : Since 1987, the Malaria Division of the Thai Ministry of Public Health has maintained a computerized database that includes all malaria cases recorded at malaria clinics, government health institutions, and private hospitals nationwide. In this article, we analyze the 1992 data.
Results : The provinces of Trad, Tak, and Kanchanaburi had the highest incidence of locally transmitted cases. Trad Province was also responsible for the highest number of imported cases. The highest incidence rate was found to be 426.5 per 1000 persons per year in a group of villages in Maesod District, Tak Province. Districts and provinces with ≥ 20 cases per 1000 persons per year are listed in this report. Peak transmission seasons and species prevalence of different endemic areas are described. Analysis of case investigation, a part of this database, indirectly supported the presence of mefloquine resistant Plasmodium falciparum strains on the Thai-Cambodian border.
Conclusions : This paper describes the characteristics of malaria in different parts of Thailand and pinpoints areas with significant transmission. However, in accordance with the present policy of the Thai national malaria control program, we do not recommend chemoprophylaxis, but we do strongly encourage personal protection, early diagnosis, and prompt treatment.