Abstract / Summary
Abstract Background: Differentiating acute malaria from other non-malarial febrile illnesses presents a critical diagnostic and triage challenge in high-volume African pediatric referral centers. While general continental trends are well-documented, localized data mapping the precise cellular and hematological divergences across specific age groups remain limited. This study sought to quantify acute hematological alterations, compare pathogen-specific cellular signatures between malaria-positive and malaria-negative cohorts, and evaluate the relationship between host age and anaemia severity. Methods: An institutional, cross-sectional analytical study was conducted at Arthur Davison Children’s Hospital (ADCH) in Ndola, Zambia. A cohort of 200 febrile pediatric patients aged 0-15 years were enrolled. Screening for Plasmodium infection was performed using combined Pf/Pan RDT kits and gold-standard microscopic examination of Giemsa-stained peripheral blood smears. Comprehensive whole-blood profiles were processed within two hours of blood collection using a calibrated automated haematology analyzer (Sysmex XN series). Results: The institutional prevalence of laboratory-confirmed malaria was 18.0% (36/200 cases). Plasmodium falciparum monoinfection predominated, accounting for 88.9% (32/36) of positive cases, followed by P. malariae (8.3%) and P. ovale (2.8%). Early childhood cohorts experienced the highest vulnerability, with the 1–4 years age group harbouring 72.2% (26/36) of all cases and exhibiting the peak mean parasitemia density of 48,500 parasites/µL. Malaria-positive cohorts displayed profound cytopenias compared to malaria-negative cohorts, marked by a significant hemoglobin deficit (6.80 g/dL versus 12.56 g/dL; mean deficit of -6.06 g/dL) and depleted red blood cell counts (2.80 versus 4.71 × 10⁶/μL) secondary to accelerated hemolysis. Concurrently, absolute platelet counts were markedly lower in malaria cases (199.7 versus 314.4 × 10³/μL), indicating severe peripheral consumption. Conversely, the malaria-negative cohort exhibited a 1.97-fold increase in total white blood cell counts (13.40 versus 6.80 × 10³/μL), profiling a signature of marked leukocytosis suggestive of non-malarial bacterial or systemic infection mimics. Conclusions: Acute Plasmodium falciparum malaria drives severe, predictable hematological shifts in Zambian children, predominantly targeting toddlers aged 1–4 years with high-density parasitemia. The distinct physiological signatures identified profound anaemia and thrombocytopenia pairing with normal leukocyte counts, contrasted against the marked leukocytosis of malaria-negative febrile peers offer a robust diagnostic framework to improve emergency triage, accelerate targeted treatment, and optimize resource allocation in resource-limited tertiary care pipeline hubs.