Thrombocytopenia is commonly seen in Plasmodium vivax malaria, but its prognostic value has not been addressed in children. This prospective study included 676 admitted children of malaria [Plasmodium falciparum (Pf) monoinfection 262, Plasmodium vivax (Pv) monoinfection 380, and mixed (Pf + Pv) infection 34], in which thrombocytopenia (platelet count <150 × 10(3)/mm(3) on admission) was found in 442 (65.38%) children [Pf monoinfection 55.3% (145/262), Pv monoinfection 73.16% (278/380), and mixed infection 55.88% (19/34)]. The association of thrombocytopenia was statistically significant with Pv monoinfection [73.16% (278/380)] in comparison to either Pf monoinfection [55.34% (145/262); odds ratio (OR) = 2.199 (95% confidence interval (CI) 1.577-3.068), p < 0.0001] or mixed infection [55.88% (19/34); OR = 2.152 (95%CI 1.054-4.394), p = 0.032]. In Pv monoinfection, thrombocytopenia was highest in 0-5 years age group and subsequently decreased with advancing age, whereas in Pf monoinfection it was reverse. Severe thrombocytopenia (platelet count <20 × 10(3)/mm(3)) was present in 16.52% (73/442) children [Pv monoinfection 21.58% (60/278) and Pf monoinfection 8.97% (13/145)]. The risk of developing severe thrombocytopenia was also highest in Pv monoinfection [15.79% (60/380)] in comparison to Pf monoinfection [10.59% (13/262); OR = 3.591 (95%CI 1.928-6.690), p < 0.0001]. Bleeding manifestations were associated in 21.27% (94/442) children [Pf monoinfection 9.92% (26/262), Pv monoinfection 16.58% (63/380), and mixed malaria 14.71% (5/34)]. All the children having bleeding manifestations had thrombocytopenia but low platelet counts were not always associated with abnormal bleeding. The association of severe malaria was significantly more among children having Pv monoinfection with platelet counts <20 × 10(3)/mm(3) [OR = 2.569 (95%CI 1.196-5.517), p < 0.014] with specificity of 88.3% and positive predictive value of 85%. Till today, thrombocytopenia is not included in severe malaria criterion described by WHO, but when platelet counts <20 × 103/mm(3), we advocate it to include as one of the severe malaria criteria.

The current study, therefore, is an attempt to identify children with learning disorders and explore the prevalence of the problem and etiological factors e.g., family environment, social factors and developmental issues of child and associated co-morbidities. More studies with larger sample size should be undertaken to get accurate picture of these disorders.There is also need for some community based programme to raise the level of awareness and knowledge about these disorders in general population.

It was observed that adolescents received less energy from carbohydrates and more from fats in comparison to the recommended standard. Sodium intake was found to be very high whereas fibre intake was low. The prevalence of hypertension was 1.5% and hypercholesterolemia 50%. The high prevalence of hypercholesterolemia was related mainly to dietary habits of these children. Thus our study shows that for the prevention of adult atherosclerotic cardiovascular disease in Indian population measures are urgently needed towards behavioral and life style modification including change in dietary habits.

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There is a high prevalence of Celiac disease in SAM. Screening for Celiac disease (especially in presence of pain abdomen and abdominal distension) should be an essential part of work-up in all children with SAM.

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Background: Recent observations from different parts of world has confirmed the existence of severe P.vivax malaria, however, the reports of severity in children are scanty.Methods: This prospective study was conducted on 168 admitted children of malaria during January 2011 to December 2011 in in medical college hospital, Bikaner (Northwest India). Species diagnosis was done by peripheral blood smear and rapid diagnostic test. Further confirmation of severe P.vivax monoinfection was done by polymerase chain reaction revealing 96.38% accuracy. Severe malaria was defined strictly on WHO criteria (2000).Results: The proportion of P.falciparum,P.vivax, and mixed infection (P.falciparum and P.vivax) was 34.5%, 53.6%, and 11.9%, respectively. Severe malaria was detected in 47.6% (80/168) children, with the risk greatest among P.vivax monoinfection (62.2% [56/90]) compared with P.falciparum, either alone (34.5% [20/58]; OR = 3.1 [95% CI = 1.49-6.62], p = 0.001) or mixed infections (20% [4/20]; OR = 6.59 [95% CI = 1.85-25.64]). In children < 5 years of age, the proportion of severe malaria attributable to P.vivax rose to 69.2% (18/26) compared with 26.9% (7/26) of P.falciparum(OR = 6.12 [95% CI = 1.58-24.79], p = 0.005) and 3.85% (1/26) of mixed infection (OR = 56.25 [95% CI = 6.00-1322.27], p < 0.0001). The proportion of children having severe manifestations, which included severe anemia, thrombocytopenia, cerebral malaria, acute respiratory distress syndrome, hepatic dysfunction, renal dysfunction, abnormal bleeding, shock and hemoglobinuria, was significantly high in association with P.vivax monoinfection in 0-5 year age group, while the same was significantly high in association with P.falciparum monoinfection in 5-10 year age group. Similarly P.vivax monoinfection had greatest propensity to cause multiorgan dysfunction in 0-5 year age group (38.9% [7/18], p < 0.01) in comparison to P.falciparum monoinfection, which had similar propensity in 5-10 year age group (66.7% [6/9],p = 0.03). The case fatality rate of severe P.vivax monoinfection was 2.8% versus 2.6% of severe P.falciparum monoinfection (p = 1.0). Conclusion:This study reaffirms the evidence of severe P.vivax monoinfection in children in Bikaner having almost similar spectrum to P.falciparum monoinfection.

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