Child morbidity and mortality due to cerebral malaria in Brazzaville, Congo. A retrospective and prospective hospital-based study 1983-1989.

This study was conducted in all four hospitals of Brazzaville, the capital of the Congo in order to assess the trend in malaria morbidity, the frequency of cerebral malaria and the related mortality between 1983 and 1989 in Brazzaville children. For the period 1983 to 1987 the study was retrospective, based on records. For the period 1988 and 1989 a prospective study was carried out in the two main hospitals in which a system for reporting cases of cerebral malaria was set up. This was completed by a retrospective analysis of data similar to that carried for the previous years. The population of Brazzaville children aged between 0 and 14 years and the distribution by district were estimated from the 1984 official census taking the annual demographic growth to be 5%. The results show a marked increase in hospitalizations for malaria, noticeable since 1985, and which now account for about 50% of the overall non-surgical hospitalizations. The number of cases of cerebral malaria and related deaths have probably increased. However, these severe forms of malaria were relatively rare. Indeed, in 1988 and 1989, for the 0-4, 5-9 and 10-14 year age groups, the annual incidence rates of cerebral malaria were estimated at respectively 240, 61 and 13 per 100,000 and the related mortality rates at respectively 58, 5 and 1 per 100,000. No obvious relationship was found between the intensity of malaria transmission, which varied considerably according to the district, and the level of mortality from cerebral malaria.

[Malaria attack: a difficult diagnosis in a region of high Plasmodium falciparum endemicity]. / L'accès palustre: un diagnostic difficile en région de forte endémicité a Plasmodium falciparum.

The diagnosis of malaria attack in regions for highly endemic P. falciparum is difficult. It is more so since the wide use of antimalarials by the infected populations and the spread of drug resistance. A positive test is not evidence for a malarial attack since in certain schools, in both rural regions and in some districts of big towns, over 3/4 of the children attending school are carriers of Plasmodium. On the other hand, true attacks, even severe forms, can occur without evidence of parasitaemia. The parasitic load is thus an important factor but the following must be taken into consideration: age, level of immunity, the extent of transmission and whether if is continuous or not, self medication and the initial systematic treatments, the possibility of drug resistance, ... The difficulties are illustrated by data collected in the Congo.