Analysis of malaria cases among United Nations troops in Sierra Leone

OBJECTIVE: To analyze malaria case presentation admitted to the United Nations hospital in Freetown, Sierra Leone named Choithram Memorial Hospital, a Jordanian Medical Level III Hospital.

METHODS: All data from patients admitted to the Choithram Memorial Hospital, Freetown, Sierra Leone, over a 6-month period, 21st January through to 21st July 2002 were tabulated and later analyzed according to clinical presentation. Data such as age, sex, most common complaints, malaria smear and history of malaria prophylaxis together with other variables were recorded.

RESULTS: A total of 101 cases were included in this study. Males accounted for the majority of cases n=90 (89.1%), females n=11 (11.9%). Mean age was 34.4+/= 9 and mean stay in hospital was 4.5+/=2 days. Malaria thick smear was positive from the first time in 71.3%, n=72, while in 16.8%, n=17 from the second time, 4%, 5%, 3% were positive from the third, fourth and fifth time. Most common complaints were fever and headache (79.2%, n=80), chills (74.3%, n=75), sweating (72.3%, n=73), arthralgias (56.4%, n=57) and vomiting (43.6%, n=44). Those who were taking anti-malarial prophylaxis were 34.6% (n=35), while the rest were on no prophylaxis. Complicated cases were: 5 cases presented with cerebral malaria, one of them succumbed while the rest recovered completely; 4 presented with uremia and were referred for dialysis, one of them passed away after the first dialysis session. Other clinical presentations were seen such as: upper gastro-intestinal bleeding, diarrhea, pneumonia, pericarditis, angina pectoris, black water fever and abdominal pain. Four consultations were received from the dermatologist on cases of chicken pox not responding to treatment and turned out to be malaria falciparum.

CONCLUSION: In an endemic area, malaria falciparum may present in very bizarre and variable clinical pictures. Fever is not necessarily a cardinal sign. High suspicion index must be exerted in unusual presentations. Prophylaxis against malaria must not alter the clinical decision away from the diagnosis. Prompt treatment on presumptive diagnosis will save many patients from the complications of this killing disease.