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Aims : Malaria continues to cause high morbidity and mortality in children. This study determined the prevalence of severe malaria, pattern of presentation and outcome at the emergency paediatric unit of Yariman Bakura Specialist Hospital, Gusau, Nigeria. Materials and methods : A descriptive retrospective cross sectional study of children aged 1 month to 12 years who fulfilled the 2000 WHOsevere malaria criteria admitted over a one year period at the emergency paediatric unit. Children with positive malaria parasite were included in the study. Children presumed to have severe malaria but with negative malaria parasite test or malaria parasite test not done were excluded. Children with sickle cell anaemia and those with features of meningitis or confirmed to have meningitis were also excluded from the study. All patients were treated with injectable artesunate followed by oral artemeter lumefantrine. Results : A total of 844 children were admitted into the paediatric wards of which 262 were managed for severe malaria but only 164(19.4%) were confirmed to have positive malaria parasitaemia. Fifty seven percent were males with M: F ratio of 1.1:1. Majority of the children were under fives (62.8%). Fever, multiple convulsions and pallor were the commonest presenting symptoms. Multiple convulsions, hyperpyrexia and prostrations were the commonest manifestations of severe malaria. Jaundice, haemoglobinuria and shock were uncommon. Only 11.6% of the children had severe anaemia warranting blood transfusion. Our case fatality rate was 8.5% while 86.6% were discharged and 4.9% left against medical advice. Conclusion : The high prevalence reflects the malaria burden in children especially under fives, despite the measures carried out to reduce malaria morbidity and mortality in the country. However our mortality is lower than what has been found in many studies which shows a decrease in mortality from malaria as has been shown by the latest WHO report.

Major clinical manifestations of hookworm infestation are consequences of chronic intestinal blood loss. Iron-deficiency anaemia may occur and patient may develop pica which is commonly seen in children.Laboratory findings of hookworm infestation with iron deficiency anaemia include hypochromic microcytic anaemia and eosinophilia. B.A is a 7 year old boy residing at a village in Zamfara, North western Nigeria. He presented with a one month history of ingestion of stones and sand. He had normal neuro-developmental milestones and does not have any neuro-psychiatric disorder. He had mild generalised abdominal tenderness with multiple cystic swellings. On rectal examination, multiple stones were felt and evacuated which range between 1 and 3 cm. Blood film showed moderate anisocytosis with few target cells, hypochromia and microcytosis. Stool microscopy showed trophozoite of Entamoeba histolytica and eggs of hook worm. Pus cells with numerous blood cells were seen. Abdominal x-ray showed multiple dense radio opacities of calcific densities in the lumen of large bowel from caecum to rectum. He had enema and a total of 180 stones were passed within three days of admission. He was treated with Fersolate, Albendazole and Metronidazole and discharged after 8 days on admission when pica had stopped. He was asked to continue iron supplement for 3 months. Our case report is unique as stones passed out in stool were kept and counted. Enema may be needed for evacuation of larger stones. Children with pica should be evaluated for hookworm infestation and iron deficiency anaemia.