Interaction Between Acute Diarrhoea and Falciparum Malaria in Nigerian Children Olugbemiro Sodeinde, 1,4 Adebowale A Adeyemo, 1 Rasheed A Gbadegesin, 1 Benjamin O Olaleye, 1 Kehinde E Ajayi-Obe, 2 and Olusegun G Ademowo 3  1 Department of Paediatrics, University College Hospital, P.M.B. 5116, Ibadan; 2 Department of Paediatrics, Lagos University Teaching Hospital, Lagos; 3 Postgraduate Institute of Medical Research and Training, University of Ibadan; 4 Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria ABSTRACT Although both malaria and diarrhoea are major public health problems in developing countries, and separately each has been the subject of intense research, few studies have investigated the interaction between these two conditions. The interaction between diarrhoea and malaria among children aged 4 months to 12 years in two tertiary health-care facilities, University College Hospital, Ibadan, and Lagos University Teaching Hospital, Lagos, Nigeria was studied. In Ibadan, the prevalence of diarrhoea among the cerebral malaria patients on admission was 11.7% (7/60) compared to 9.3% (215/2312) among other admissions in 1990 (chi square=0.16; p=0.6913). Similarly, no significant difference in the prevalence of diarrhoea was found between the cerebral malaria patients (14.3%) and other patients (16.1%) seen in Lagos in 1992 (chi square=0.06, p=0.81). Thus, cerebral malaria does not seem to be associated with an increased or decreased prevalence of diarrhoea when compared with other conditions. The prevalence of malarial parasitaemia among the 554 diarrhoea patients studied in Ibadan during 1993-1994 was 13.6% compared with 17.9% among the 347 controls (chi square=3.75, p=0.053). However, of the children with diarrhoea, malarial parasitaemia was more common among the dehydrated patients (25.4%) than among the well-hydrated patients (11.6%) (chi square = 8.11, p=0.004). These data suggest that diarrhoea is merely coincidental in severe malaria and conversely, malarial parasitaemia is similarly coincidental in children with acute diarrhoea, although it may be more frequent among dehydrated diarrhoea patients than well-hydrated ones. Keywords: Malaria; Diarrhoea, Infantile; Diarrhoea, Acute; Dehydration; Prospective studies INTRODUCTION Both malaria and diarrhoea are the major public health problems in children in the tropics, and both conditions are major causes of mortality in children aged less than 5 years (1,2). Although both conditions are the subjects of intense research and health policy, little information on the interaction between the two diseases is available. In one study, Greenwood et al. (3) did not find any interactions between acute gastroenteritis, acute respiratory infections, and malaria. By contrast, the interaction between acute respiratory infections and malaria has more frequently been studied (4-6). Malaria, long recognized as a major cause of morbidity and mortality in African children, does not have any specific clinical features (7). In Plasmodium falciparum-associated infections, which account for 97% of malaria in Nigeria, fever and convulsions are common, while vomiting and diarrhoea also occur (8). Therefore, it is not surprising that, according to some studies, diarrhoea is a prominent symptom of malaria (9,10), while other studies assert that malaria can seldom be incriminated as the primary cause of significant diarrhoea (11). In recognition of the overlap that may exist between the two conditions and the possibility that both conditions may coexist in the same child, the Control of Diarrhoeal Diseases (CDD) Programme of the World Health Organization (WHO), recommends that in areas of endemic malaria, a child with diarrhoea aged 2 months or older and whose temperature is >38 ° C, should be treated for