title: Parasite density and malaria morbidity in the Pakistani Punjab.
abstract: The relationship between quantitative Plasmodiumfalciparum or P. vivax parasitemia and clinical illness has not been defined in Pakistan or in other areas where malaria transmission is not highly endemic. Standardized questionnaires were given to and physical examinations and parasitologic tests were performed in 8,941 subjects seen in outpatient clinics in 4 villages for 13 consecutive months in the Punjab region of Pakistan. The results, based on multivariable analysis, showed that a clinical diagnosis of malaria, a history of fever, rigors, headache, myalgia, elevated temperature, and a palpable spleen among children were all strongly associated with the presence and density of P. falciparum or P. vivax malaria in a monotonic dose-response fashion. The malaria attributable fraction of a clinical diagnosis of malaria, and the same symptoms and signs also increased with increasing P. falciparum and, to a lesser extent, P. vivax, parasitemia. Unlike in sub-Saharan Africa, clinical illness due to malaria often occurs in the Punjab among adolescents and adults and in patients with parasite densities less than 1,000/microl. Clinical guidelines based upon parasitemia and symptomatology must be adjusted according to the intensity of transmission and be specific for each geographic area.
authors.affiliation: International Health Program and Department of Epidemiology and Preventive Medicine, School of Medicine, University of Maryland-Baltimore, 21201-1596, USA.
authors.forename: D
authors.initials: D
authors.lastname: Prybylski
authors.forename: A
authors.initials: A
authors.lastname: Khaliq
authors.forename: E
authors.initials: E
authors.lastname: Fox
authors.forename: A R
authors.initials: AR
authors.lastname: Sarwari
authors.forename: G T
authors.initials: GT
authors.lastname: Strickland
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000818:Animals; D000852:Anopheles / Q000254:growth & development; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007303:Insect Vectors / Q000254:growth & development; D016778:Malaria, Falciparum / Q000453:epidemiology* / Q000635:transmission; D016780:Malaria, Vivax / Q000453:epidemiology* / Q000635:transmission; D008297:Male; D009017:Morbidity; D015999:Multivariate Analysis; D010154:Pakistan / Q000453:epidemiology; D018512:Parasitemia / Q000453:epidemiology / Q000635:transmission; D010963:Plasmodium falciparum / Q000302:isolation & purification* / Q000472:pathogenicity; D010966:Plasmodium vivax / Q000302:isolation & purification* / Q000472:pathogenicity; D015995:Prevalence; D012621:Seasons; D016036:Seroepidemiologic Studies; D013163:Splenomegaly; D011795:Surveys and Questionnaires