Interaction between acute diarrhoea and falciparum malaria in Nigerian children.

Although both malaria and diarrhoea are major public health problems in developing countries, and separately each has been the subject of intense research, few studies have investigated the interaction between these two conditions. The interaction between diarrhoea and malaria among children aged 4 months to 12 years in two tertiary health-care facilities, University College Hospital, Ibadan, and Lagos University Teaching Hospital, Lagos, Nigeria was studied. In Ibadan, the prevalence of diarrhoea among the cerebral malaria patients on admission as 11.7% (7/60) compared to 9.3% (215/2312) among other admissions in 1990 (chi square = 0.16; p = 0.6913). Similarly, no significant difference in the prevalence of diarrhoea was found between the cerebral malaria patients (14.3%) and other patients (16.1%) seen in Lagos in 1992 (chi square = 0.06, p = 0.81). Thus, cerebral malaria does not seem to be associated with an increased or decreased prevalence of diarrhoea when compared with other conditions. The prevalence of malarial parasitaemia among the 554 diarrhoea patients studied in Ibadan during 1993-1994 was 13.6% compared with 17.9% among the 347 controls (chi square = 3.75, p = 0.053). However, of the children with diarrhoea, malarial parasitaemia was more common among the dehydrated patients (25.4%) than among the well-hydrated patients (11.6%) (chi square = 8.11, p = 0.004). These data suggest that diarrhoea is merely coincidental in severe malaria and conversely, malarial parasitaemia is similarly coincidental in children with acute diarrhoea, although it may be more frequent among dehydrated diarrhoea patients than well-hydrated ones.