1. Background

Malaria is a big health problem and is endemic in an area where around two billion people Live ^[1]. Plasmodium falciparum and Plasmodium vivax are the two major species of malaria infecting humans ^[2]. Plasmodium vivax threatens nearly half the world’s population ^[3]. It is responsible for approximately 70 to 80 million cases of malaria worldwide annually, and is the major cause of human malaria in parts of Pacific region and Central and South America ^[4]. Compared to Plasmodium falciparum, Plasmodium vivax has a much wider distribution outside Africa and it extends far into the temperate zones.

Clinical manifestations include symptoms that are non specific and can not be distinguished reliably from other febrile illnesses or other malarias. High fever and rigors are more common in Plasmodium vivax than Plasmodium falciparum malaria, reflecting synchronicity of schizont rupture ^{[5, 6]}.

Recently, Plasmodium vivax has been shown to be not as benign as it was previously thought and is associated with complications, such as severe anaemia, respiratory distress, malnutrition, and even coma ^[7] in addition to severe anaemia, jaundice, thrombocytopenia, hypotension, cerebral malaria, epistaxis, renal impairment, hypogylcaemia and more than one manifestation in children ^[8]. prevalence of Plasmodium vivax was found 66% when a study was conducted for the prevalence of Plasmodium vivax malaria in children < 10 years old living in 10 rural villages on the island of Espiritu Santo, Vanuatu, south-west Pacific ^[9]. In Korea, 53 (53 %) patients were infected with Plasmodium vivax when blood smears were examined under microscope when a study carried out there. ^[10] In Pakistan the prevalence of Plasmodium vivax in children among 7899 suspected cases of malaria was 642 (8.1 %) ^[11]. A study carried out in southern Papua, Indonesia revealed the prevalence of Plasmodium vivax of the 187 infants aged <3 months was102 (56%). ^[12] Out of seven thousand eight hundred fifty two suspected cases of malaria, 2092 (26.64 %) were found to be positive for vivax malaria in children. On the other hand, suspected cases, 896 (24.58 %) were found to be positive for malarial parasites with 52.67 % (472/896) identified as Plasmodium vivax. And out of 4208 suspected cases, 1196 (28.42 %) were found to be positive for malarial parasites with 69.89 %( 836/1196) identified as Plasmodium vivax. (These were in Mastung and Khuzdar areas of Pakistan respectively.) ^[13] A study was conducted for prevalence of Plasmodium vivax in primary school students (5-15 years) from 11 schools in rural areas of Bannu district, Pakistan were examined by smear survey, a total of 556 blood smears were studied of which17 (3.05%) were found positive for malarial parasite. Screening of all these blood films showed that prevalence of Plasmodium vivax was (2.69%) ^[14]. Prevalence of Plasmodium vivax malaria is relatively high in Ethiopia (32.6 %) ^[15]. Plasmodium vivax malaria is treated by Artemether-lumefantrine (AL), the most commonly deployed Artemisinin-based combination therapy (ACT), has shown rapid clearance of Plasmodium vivax parasitemia and fever. The relatively short half-life of lumefantrine would appear beneficial in terms of reducing risk of resistance when compared to other (ACT) ^[16]. Plasmodium vivax species produce hypnozoites, a persistent liver stage. Elimination of these dormant-stage parasites (socalled radical cure) is necessary to prevent relapse that may otherwise occur weeks to months after the original infection. Primaquine (0.5 mg [base form]/kg/day, up to 30 mg/day, for 14 days) is recommended by the U.S. Centers for Disease Control and Prevention. G6PD deficiency should be ruled out prior to treatment with primaquine to avoid drug-induced hemolysis. The WHO guidelines for radical cure differ from CDC’s, recommending a lower dosage of primaquine: 0.25 mg[base form]/kg/d (up to 15 mg/day) for 14 days, perhaps out of concern for G6PD deficiency ^[17]. The aim of this study was to determine the prevalence of Plasmodium vivax malaria among children attending at AlKiwety Paediatric Hospital in Kassala, eastern Sudan.

2. Methods

Two thousand, eight hundred and seven febrile children attended at Alkiwety Paediatric Hospital, in Kassala city (Figure 1), they were come from different areas of Kassala state, during January and February 2012 screened for P.vivax, were received from records of the hospital. One thousand, four hundred and fifty three (51.8%) of them were males and 1354 (48.2 %) were females. Thick and thin blood films were prepared, directly from capillary blood. The films were made soon after collecting the blood and stained with Giemsa stain. Thick films were handled with care to prevent the blood being washed from the slide during staining and examined under microscope with X100 oil immersion lens, for malaria parasites. Blood films were considered negative if no parasites were detected in 100 oil-immersion fields of a thick blood film. ^[18].

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Figure 1. Kassala Map

3. Data Analysis and Ethical Approval

Data were entered in computer using SPSS for windows version 16.0. Compared between the blood film for malaria and different variables using Chi Square test and P value < 0.05 was considered significant. All authors read and approved the final manuscript.

4. Results

Two thousand, eight hundred and seven febrile children (from inside Kassala and also rural areas around Kassala who attended at Alkiwety Paetiatric Hospital, were screened for malaria by blood film, 2305 (82.1 %) were under five year and 502 (17.9) were more than five and up to 18 year. 1453 (51.8 %) were males and 1354 (48.2 %) were females.1272 (45.3%) lives in Urban area and 1535 (54.7%) lives in Rural area. 1330 (47.4%) were Rashiada, 477 (17%) were Bija, 378 (13.5%) were Housa, 527 (18.8%) were Northern and 95 (3.4%) were Others. 2163 (77.1%) presented complain of Fever, 156 (5.6%) presented complain of Headache, 526 (18.7%) presented complain of vomiting, 73 (2.6%) presented complain of Nausea,. 41 (1.5%) having Plasmodium vivax and 2766 (98.5%) having other types of malaria and negatives. There was significant relationship between Plasmodium vivax malaria and tribes (Table 1) and residence (p value = 0.03 & 0.04) respectively. There was no significant relationship between Plasmodium vivax infection and gender, age, headache, nausea and fever (p value: 0.70, 0.49, 0.23, 0.36 and 0.60) respectively.

Table 1. Vivax malaria and Tribes

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5. Discussion

Two thousand and eight hundred and seven children were screened for malaria by blood film, in the study area, 2305 (82.1 %) were under five year and 502 (17.9) were more than five and up to 18 year. 1453 (51.8 %) were males and 1354 (48.2 %) were females. The prevalence of Plasmodium vivax malaria was 1.5 % (41/2807). Our result was different from a study carried out in sub-Saharan Africa ^[19]. In additions, it was different from a study carried out in Venezuela, ^[20] also it was different from a study performed in the Brazilian Amazon ^[21] and different from a study conducted in southern Papua, Indonesia ^[12]. The study carried out in Pakistan same as ours; it may be due to the same environment and tribes. In our study the prevalence of Plasmodium vivax malaria was low (1.5 %) comparing to the neighbour countries such as Ethiopia (32.6 %) ^[15]. Also in our study Plasmodium vivax malaria was more prevalent in Rashida tribe, it may be due to the traveling of Rashida to Ethiopia for trading. Besides, the infection of Plasmodium vivax malaria was high among rural people than urban, this may be due to Rashida tribe, who are inhibiting the rural areas commonly.

6. Conclusion

Educational health programs should be introduced in the study area particularly among rural people. Also people should be encouraged to use impregnated bed nets. Health authority in Kassala state should provide rural health care centers with anti-malarial drugs especially for the dormant stages of the parasites such as Primaquine. Moreover, Record Centers should be established for P.vivax distribution in Kassala State.

Ethical Clearance

This study was approved by ethical clearance committee, research board, Faculty of Medicine & Heal;th Science, University of Kassala, Kassla, Sudan.

Competing Interests

The authors declare that they have no competing interests.

Acknowledgements

We are grateful to Alkiwety Paediatric Hospital staff, in Kassala city for their helping to receive the recorded data of this study.

References

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