Malaria in a rural area of Sierra Leone. II. Parasitological and related results from pre- and post-rains clinical surveys

The prevalence of Plasmodium falciparum in a cohort of over 900 nought to seven-year-old children living in a rural area of Sierra Leone was found to be approximately 61%, both before and after the rainy season. Plasmodium malariae rates measured in the same children were approximately 12%, and P. ovale rates averaged about 1%. Spleen rates averaged 44% for the two surveys; the age prevalence spleen profiles closely matched those for P. falciparum. The overall gametocyte rates for both P. falciparum and P. malariae were roughly one fifth of the prevalence rates for the asexual parasites. However, whilst there was no difference between the P. falciparum gametocyte rates at the two surveys, the P. malariae rate was significantly higher post-rains when compared with the pre-rains result. Spleen size did not increase with increased parasite density. There was a statistically significant difference between the geometric mean P. falciparum trophozoite densities of febrile and afebrile children both before and after the rainy season, but there was little seasonal difference in the means for the febrile children or in those for the afebrile children. Antimalaria antibody levels, measured by ELISA and IFAT, showed no significant differences at either survey. The levels found were high for all age groups, indicating that exposure to malaria begins at birth. Our results indicate that, in the area studied, malaria is hyperendemic and is probably transmitted perennially.