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Malaria Outbreak, Riyadh city, January/February 1998.


From January 1 to the end of February 1998 (from the end of Ramadan to the end of Shawwal 1418) there were large number of malaria cases in Riyadh city, a large number of these cases were severe malaria cases and admitted in the hospitals. The objective of this study is to determine the frequency of severe malaria and the predictor factors of severity.


A malaria case was defined as any patient admitted to Riyadh hospitals between Jan - March, 1998 which was not imported. Severe malaria was defined as any patient with any of these symptoms: deep coma, convulsion, anemia, neurological abnormality, hyperpyrexia, renal failure, hepatic dysfunction, pulmonary edema, circulatory collapse, splenic rupture, absent corneal reflexes, decerebrate rigidity, intensive care unit (ICU) admission, deaths. Malaria cases were collected from the infection control office, parasitology laboratory and Riyadh Directorate affaires. Interviews were conducted personally or by telephone.


Out of 79 cases. 97% were Saudis. The mean age was 20; 56% were (0-19 years), 85% were males, 88% were travelers to Jazan; the others from nearby provinces. no deaths were reported. 8% had deep coma. 5% were admitted to ICU. The mean number of days they were admitted to the hospital was 5 days (V=4.2 SD=4.1), range (3 to 28) days. 8% of the patients had a parasite count of 5000?L


We found that all of the patients had traveled to Jazan and other provinces in Southern Saudi Arabia, and were not immune to malaria. The patients did not seek treatment as soon as they arrived and the doctors did not diagnose malaria in the first visit. Therefore the patients did not receive the correct medicine making for a high severity score. Most of the patients were children and adult males, perhaps, since these two groups are more often outside the home than females. Also, females wear an abaya (covering) when they leave their homes. To identify malaria patients easily and early, malaria should be added to the surveillance system in Riyadh city. Factors that predispose to severe malaria were identified: Non-immune people traveling to endemic areas, doctors not diagnosing the cases early enough, patients not seeking treatment early enough, especially among children.