FREQUENCY OF RELAPSE OF MALARIA IN CHILDREN PRESENTING WITHPLASMODIUM VIVAX AT GHULAM MUHAMMAD MAHAR MEDICALCOLLEGE HOSPITAL SUKKUR

Abstract

Objective: To determine the frequency of relapse of malaria in children presenting with Plasmodium Vivax malaria, Sukkur.

Methods: This was a cross-sectional study conducted at the Department of Pediatric Medicine, Ghulam Muhammad Mahar Medical College (GMC), Sukkur, from September 1^st, 2024, to February 28^th, 2025, using a non-probability consecutive sampling technique. Children aged 2 to 16 years of either sex with confirmed Plasmodium vivax malaria were included. Exclusion criteria were respiratory infections (cough, runny nose, fever >100°F), gastroenteritis (more than three loose stools or vomiting over five episodes daily), enteric fever (fever >7 days or positive culture), and measles (cough, coryza, conjunctivitis, and rash starting on face). After approval from the College of Physicians and Surgeons Pakistan, informed consent was obtained from parents. Demographic data (age, gender, residence) were collected. Confirmed cases received chloroquine 25 mg/kg orally once daily for three days. Patients were followed to identify relapse per operational definition. Clinical, sociodemographic, geographic, and socioeconomic data were recorded using a standardized proforma. Strict exclusion criteria helped minimize bias.

Results: Out of 130 children presenting with Plasmodium vivax malaria, 87 (66.9%) were male and 43 (33.1%) were female, indicating a higher prevalence among males. The mean age was 8.63 ± 4.18 years, with mean weight 26.12 ± 10.52 kg, height 117.12 ± 19.12 cm, and BMI 18.01 ± 1.85 kg/m². Most children, 107 (82.3%), were from rural areas, highlighting a higher burden in these regions. The relapse frequency was 25 cases (19.2%), with 105 children (80.8%) not experiencing relapse. Clinically, chills and shivering were most common (90.8%), followed by headache (49.2%) and vomiting (15.4%). Maternal education levels varied, with 24.6% primary, 30.8% secondary, 17.7% matriculation, 14.6% intermediate, and 12.3% graduates. A significant association was found between gender and relapse (p=0.025), with females relapsing more (30.2%) than males (13.8%). Relapse was also significantly linked to rural residence (p=0.046), with 24 of 25 relapses in rural children. Maternal education showed a non-significant trend toward higher relapse in lower education levels (p=0.176; linear trend p=0.042). No association was found between age and relapse (p=0.484). Mean illness duration was 4.09 ± 1.56 days.

Conclusion: The study emphasizes the complexity of interactions between gender, geography, and sociodemographic variables when considering the so-called malaria relapse in children with P. vivax. The findings claim the need for gender-specific studies, rural-based intervention, and community education in order to enhance the prevention and control of relapse and ultimately have better malaria control in the endemic regions.