36 Imported Severe and Complicated Malaria at the Hospital for Sick Children, Toronto, 1989–2001
Bibliographic record
Abstract
Imported malaria is a growing problem in Canada. Malaria is associated with considerable morbidity and mortality especially in children. The objective of this study was to determine the demographics, risk factors, and management of imported paediatric malaria at our hospital between 1989–2001. A retrospective chart review was conducted on all inpatient cases of malaria treated at The Hospital for Sick Children (HSC) between 1989–2001. Charts were identified by the discharge diagnosis in the Health Records Department. Study approval was provided by our hospital Research Ethics Board. Over the 12-year study period, 72 children were treated for malaria as inpatients at the HSC. This represents a 50% increase in the average number of cases a year admitted to our hospital compared to the previous ten years. The majority (72%) of cases were caused by Plasmodium falciparum acquired in Africa. Ninety-five percent of cases were identified in new immigrants or in children of new Canadian families returning to their country of origin to visit friends and relatives (VFRs). Of the Canadians traveling abroad to endemic countries, 58% sought pre-travel advice and were prescribed chemoprophylaxis against malaria. However, only 16% took the medication according to recommended guidelines. Once these patients returned to Canada, physicians missed the diagnosis of falciparum malaria in 29% of cases, leading to a delay in diagnosis by 4.8 days. Of the 52 cases of falciparum malaria, 18 (35%) met WHO criteria for severe malaria including cerebral malaria (25%) and severe anemia requiring transfusion (25%). According to current WHO and Health Canada guidelines, treatment was inappropriate in 61% of cases. No patients in the study population died. Imported malaria in children, particularly severe falciparum malaria, is on the rise in Toronto. Immigrant children and Canadian-born children to VFR parents represent the major risk group for imported paediatric malaria. Few if any of these children were adequately protected with appropriate chemoprophylaxis. Upon return to Canada, the diagnosis of malaria in these children was frequently missed or delayed. Due to the potential for life-threatening complications and increasing drug resistance, therapy for severe malaria in Canada should include intravenous quinine (including a loading dose) plus a second agent such as clindamycin, doxycycline (for those older than age 7 years), or atovaquone-proguanil.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".