title: A local, regional, and national assessment of pediatric malaria in the United States.
abstract: BACKGROUND
  Imported malaria remains a public health concern in the United States, but the health impact on children and the financial costs to society have not been well defined.
  
  
  METHODS
  Inpatient and outpatient malaria cases diagnosed at Children's National Medical Center (CNMC) in Washington, DC over an 8-year period are retrospectively reviewed. Cases are mapped against Census Bureau population data. These observations are compared with the national burden of pediatric malaria, including both disease severity and cost, by reviewing inpatient malaria cases in the Pediatric Health Information System (PHIS), January 2003 to June 2008.
  
  
  RESULTS
  At CNMC, malaria most commonly affects children who traveled to West Africa to visit friends and relatives. Poor adherence to prophylaxis and self-treatment with antimalarial medications were commonly identified. Mapping demonstrates case clustering in communities with large sub-Saharan African populations. The cumulative incidence (CI) of malaria at CNMC of 9.0 per 10,000 admissions is 7.6 times the national average. The CI of malaria at PHIS hospitals is 1.2 per 10,000 admissions with an average cost of $17,519.
  
  
  CONCLUSIONS
  Malaria is a preventable disease for which the risk to life and costs of treatment are significant. Patterns of risk can be used by health planners to target prevention strategies at the community level. In regions with a high density of immigrants, particularly from sub-Saharan Africa, physicians must be aware of the risk, understand recommended prophylaxis and treatment regimens, and advocate for their appropriate use in the community.
authors.affiliation: Department of Preventive Medicine & Biometrics, Uniformed Services University, Bethesda, MD, USA.
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Hickey
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Cape
authors.forename: Penny
authors.initials: P
authors.lastname: Masuoka
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Campos
authors.forename: William
authors.initials: W
authors.lastname: Pastor
authors.forename: Edward C
authors.initials: EC
authors.lastname: Wong
authors.forename: Nalini
authors.initials: N
authors.lastname: Singh
mesh_terms: D000293:Adolescent; D000349:Africa / Q000208:ethnology; D000704:Analysis of Variance; D000962:Antimalarials / Q000627:therapeutic use; D019352:Censuses; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D004219:District of Columbia / Q000453:epidemiology; D005260:Female; D017048:Health Care Costs; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008288:Malaria / Q000191:economics / Q000453:epidemiology* / Q000517:prevention & control; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010372:Pediatrics; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
chemical_list: D000962:Antimalarials