Childhood malaria in Africa.

300-400 million acute cases of malaria occur annually worldwide. There are 1-2 million deaths per year globally, primarily in children. Over 80% of the world's cases of malaria occur in Africa. Early diagnosis and prompt treatment are essential. Since 92% of childhood deaths occur at home, mothers and caretakers must be informed about the symptoms of malaria and seek treatment. Cumbersome diagnostic policies, unstable supplies of drugs, high costs (time, transport, and fees), and traditional beliefs about malaria discourage people who are seeking treatment. Since many childhood diseases that cause fever overlap with malaria, a single therapy treating both illnesses is recommended. Prompt diagnosis can be achieved by better training in recognition of clinical signs and by improved laboratory testing. Simple, effective guidelines on the management of malaria are needed by the health services and the private sector. Laboratory diagnosis is important because of drug resistance and seasonal differences. Based on clinical symptoms alone, 54.2% of cases were correctly diagnosed in the Sahel during the rainy season; 3.6% were in the dry season. Hospitalization is recommended for severe cases of malaria; however, most people in Africa are unable to afford the cost of transportation and hospitalization. Because of this, preliminary treatment should begin at the health facility. For children, intramuscular quinine is as effective as that given intravenously. Alternate injection sites are required. An alternative antimalarial is sulfadoxine-pyrimethamine. Clinical improvement is maintained and the increase in hemoglobin is greater than with chloroquine. In areas where R-III resistance to chloroquine exists (more than 5-10% of cases do not show clinical improvement that lasts more than 14 days or sufficient hematological recovery), the therapy for Plasmodium falciparum malaria should be changed. The aforementioned combination therapy is more expensive than chloroquine, but the savings achieved due to the decreased need for repeated treatment and patient transport, the less severe anemia, and the reduced morbidity and mortality would offset the cost. National guidelines need to be developed.