Malaria Among Refugee Children at Arrival in the United States

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Abstract
Malaria infects >70% of children at any given time in highly disease-endemic areas, such as parts of West Africa. Many infected children are asymptomatic. There are no published data regarding the prevalence of malaria among refugee children arriving in the United States from highly disease-endemic areas. This study was performed to determine the prevalence of malaria among asymptomatic children from West Africa. A retrospective chart review for Liberian refugee children arriving in the United States was conducted from 1997 to 2000. Fifty-seven charts were reviewed. There were 28 (64%) positive thick and thin blood smears among the 44 children who had malaria smears performed during refugee medical screening examinations. There were 3 children who had been treated recently for malaria. An additional 3 children had splenomegaly and were treated for presumed malaria. Overall, the prevalence rate was 60% (34 of 57 cases). No sign or symptom, singly or in combination, was sufficient to predict the presence or absence of malaria. However, splenomegaly, fever and thrombocytopenia were highly specific for malaria and should alert clinicians to the likelihood of the diagnosis. Twenty-nine percent of children with malaria were asymptomatic. The results of this study suggest that refugee children arriving from West Africa have a significant burden of malaria. It is recommended that children who arrive in the United States as refugees from West Africa be subjected to a thorough physical examination, complete blood count and malaria blood smear.