doi:10.1111/j.1365-3156.2011.02738.x
Short communication
Summary
In patients with malaria, parasitaemia is usually estimated by assuming 8000 white cell counts (WCC)
per microlitre of blood. In a sample of 3044 African children under 5 years of age with uncomplicated
falciparum malaria, parasitaemia estimated using standardised WCC was compared to parasitaemia
calculated based on each childs own WCC. The two methods produced comparable results. However,
WCC were >8000 in under-fives with an inverse relationship with age, resulting in the standard
approximation method significantly underestimating parasitaemia in the youngest age group and
overestimating parasitaemia in the oldest age groups.
keywords malaria, parasitaemia, white cell counts
P. Olliaro et al. Standardised vs. actual white cells to estimate malaria parasitaemia
Age
(year)
<1
1
2
3
4
Total
WBC
( 109 l)
Parasitaemia
calculated on
actual WCC
Parasitaemia
estimated on
standardised
8000 WCC
220
370
863
866
725
3044
10 167
9634
9095
8507
8072
8827
15
18
19
17
18
18
13
17
19
18
19
18
125
365
905
920
090
334
031
822
988
749
603
681
Relative
difference
(%)
)16
)3
0
4
8
2
0.001
0.195
0.238
0.395
0.076
0.277
552
P. Olliaro et al. Standardised vs. actual white cells to estimate malaria parasitaemia
Table 2 Estimated (as reported in the publication) and actual [recalculated using actual white cell counts (WCC)] pre-treatment
parasitaemia by site (geometric mean)
WCC ( 109 l)
Age (years)
Site
Mean
SD
Mean
SD
Parasitaemia
calculated on
actual WCC
Burkina Faso-Pouytenga
Cameroon-Mendong
Gabon-Lamberene
Kenya-Migori
Madagascar-Tsiroanomandidy
Mali-Bancoumana
Mali-Bougoula
Rwanda-Kicukiro
Rwanda-Mashesha
Rwanda-Rukara
Senegal-Mlomp
Uganda-Kampala
Zanzibar-Kivunge
Zanzibar-Micheweni
Total
582
72
71
28
55
94
669
174
218
250
204
249
278
100
3044
2.0
2.9
3.2
2.4
3.3
3.0
2.3
2.9
2.8
2.3
3.1
3.2
2.4
2.0
2.5
1.2
0.9
0.9
1.6
0.8
0.9
1.2
1.0
1.0
1.0
0.9
0.8
1.2
1.2
1.2
11.5
8.2
8.2
9.9
7.7
10.6
10.4
6.8
5.4
4.0
11.2
9.1
6.3
6.5
8.8
4.8
2.1
2.9
4.2
2.9
3.6
4.4
2.6
1.6
1.6
4.6
3.8
3.1
1.5
4.5
18
57
26
30
10
31
19
27
14
17
25
11
11
13
18
797
345
492
864
145
787
164
999
331
641
846
682
777
432
334
Parasitaemia
estimated on
standardised
8000 WCC
14
54
27
27
10
23
15
35
21
37
20
11
16
17
18
0.001
0.146
0.920
0.007
0.409
0.001
0.001
0.001
0.001
0.001
0.001
0.020
0.001
0.001
0.277
151
353
597
402
456
813
935
295
942
676
129
035
479
026
681
30
(a)
150 000
200 000
100 000
(b)
20
10
50 000
0
<1
2
Age (year)
<1
2
Age (year)
Figure 1 Relationship between age and parasitaemia (calculated on actual white cell counts) (a) and white cells counts (b) on admission.
The red dotted horizontal line represents the geometric mean of the estimated parasitaemia for the entire age range. WCC, white cells
counts.
P. Olliaro et al. Standardised vs. actual white cells to estimate malaria parasitaemia
Corresponding Author Piero Olliaro, Special Programme for Research & Training in Tropical Diseases (TDR), World Health
Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland. E-mail: olliarop@who.int
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