2
9
thrombocytopenic values which occur in both unc1o1m-13pli-
cated and severe falciparum malarial infections. In
weeks of presentation were excluded. Children with
systemic diseases e.g leukaemia and other malignancies
that involve the bone-marrow and those with an obvious
focus of infection, with a positive blood culture exami-
nation were all excluded. Controls were afebrile appar-
ently healthy children, matched for age and gender who
showed no signs of any systemic disease and had no
parasitologic evidence of malaria. They were selected
from children attending child welfare clinic for growth
monitoring and those presenting for immunization. Also
children who presented to the out-patient clinic for
school entry medical examination were recruited.
non-endemic countries such as United Kingdom, France,
Sweden, studies done showed a varying prevalence rate
of thro1m4-b17ocytopenia in malaria to be between 64% -
8
7.3%.
In a study in Dakar, Senegal where malarial
transmission is hypo-endemic, that8 is, low and seasonal,
1
a prevalence of 56.2% was seen. In holoendemic ma-
laria countries like Pakistan, India, Kenya, Cameroon,
and Nigeria, varying prevalence rates have been9-2d1ocu-
1
mented to be as low as 13% and as high as 90%.
The
prevalence of thrombocytopenia with falciparum parasi-
taemia has been mostly documented in adult populations
of semi-immune and non-immune individuals, but there
have been few documentation for children in the tropical
region of Africa, more so in Nigeria, where malaria is
endemic. This study was therefore designed to establish
A clinical history was obtained from the care-giver and/
or the patient and included the onset and duration of
0
fever (temperature ≥ 37.5 Celsius) and associated symp-
toms. Uncomplicated malaria was established by micro-
scopically confirmed malaria parasitaemia with no
symptoms of severity. Children with repeated convul-
the preva7-l9e,1n9ce of thrombocytopenia (platelet count <100
9
x 10 /L)
in children aged six months to fifteen years
o
with falciparum malaria infection as seen in a locality in
Nigeria. The practice of paediatrics in the tropics does
not always permit a detailed diagnostic work-up for
every child with haematological manifestations therefore
research on the prevalence and aetiologic patterns is
important. It will serve as a guide to improve clinical
treatment and outcome.
sions, hyperpyrexia (axillary temperature ≥39.5 celsius),
respiratory distress, oliguria (urinary output < 1ml/kg/
hr), cardiovascular shock, jaundice, severe prostration,
haemoglobinuria, severe anaemia (Haemoglobin<5g/dl),
hyperparasitaemia (involving > 5% of erythrocytes),
hypoglycaemia (serum glucose < 2.2mmol/l), acidosis
(bicarbonate <,4 15mmol/l) were classified as having se-
3
vere malaria. Children presenting with an episode or
repeated episodes of convulsions had a lumbar puncture
done for cerebro-spinal fluid analysis to exclude bacte-
rial meningitis. A complete physical examination was
done. Level of consciousness was assessed using the
Blantyre’s score for children younger than two years and
Glasgow score for older children.
Subjects and Methods
The study was carried out in the Children Out-patient
(
CHOP) clinic, Children Emergency Unit (CHEU) and
the Paediatric ward of the University of Uyo Teaching
Hospital (UUTH), Uyo in Akwa-Ibom State. The Teach-
ing Hospital is the only tertiary health institution in the
state, and is located on the outskirts of Uyo, six kilome-
tres from the centre of the city. Uyo, the capital city of
Akwa-Ibom State is located in the South-south region of
Nigeria. It lies between latitudes 4’33 and 5’33 North,
longitudes 7’35 and 8’35 east, and falls within the tropi-
cal zone where the anopheline mosquito habitat exists.
Thick and thin blood films for malaria parasite were
prepared directly from capillary blood and the slides
stained on the same day with the Giemsa stain. Each
blood film was examined microscopically using the
100X objectives and the 7X eyepieces as these give a
brighter and clearer image. The parasite density was
determi2ned using the method by Greenwood and Arm-
2
strong who found this method to be more accurate and
quicker than counting the parasites against white cells.
The platelet count were determined using the fully auto-
mated blood cell analyser (Sysmex KX-21N). For any
samples which contained a significant proportion of
giant platelets, small platelets or did not show any plate-
let count, indicated by a flag signal from the machine,
the manual counting method was performed for confir-
mation.
Approval for the study was obtained from the hospital’s
Ethics committee before commencement. A written and
verbal informed consent was obtained from each child if
up to twelve years old and above or from the parents/
guardian(s) for younger children.
Children aged six months to fifteen years of age with
fever or a history of fever of not longer than seven days
duration before presentation in hospital with parasi-
tologic evidence of malaria were included. Also in-
cluded were children with fever and at least one or more
features of severe malaria, as well as those who had not
received any anti-malarial drug in the preceding two
weeks of presentation to hospital. Any child who had
received any cytotoxic drug and other drugs that inter-
fere with platelet counts e.g non-steroidal anti-
inflammatory drugs (NSAIDS) such as aspirin, Ibupro-
fen etc, within ten days of presentation, as well as those
who had received any anti-malarial treatment within two
Thrombocytopenia was def2i3n-2e5d in this study as a platelet
9
count < 100,000 x 10 /L.
Severe thrombocytopenia
9 2
was defined as a platelet count < 50,000 x 10 /L. Aero-
bic and anaerobic blood cultures were done on each
child. Random blood sugar was also done using a One-
Touch Ultra-2 glucometer (Life scan model Inc.
Milpitas, CA.USA 95035) on every child presenting
with clinical features of severe malaria. Values less than
2.2mmol/l were considered as hypoglycaemia.