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A cross-sectional study of asymptomatic Plasmodium falciparum infection burden and risk factors in general population children in 12 villages in northern Uganda

Maziarz, Marlena LU ; Nabalende, Hadijah; Otim, Isaac; Legason, Ismail D.; Kinyera, Tobias; Ogwang, Martin D.; Talisuna, Ambrose O.; Reynolds, Steven J.; Kerchan, Patrick and Bhatia, Kishor, et al. (2018) In Malaria Journal 17(1).
Abstract

Background: Plasmodium falciparum malaria is an important cause of morbidity in northern Uganda. This study was undertaken to assess village-, household-, and individual-level risk factors of asymptomatic falciparum malaria in children in 12 villages in northern Uganda. Methods: Between 10/2011 and 02/2014, 1006 apparently healthy children under 16 years old were enrolled in 12 villages using a stratified, multi-stage, cluster survey design and assessed for P. falciparum malaria infection using the rapid diagnostic test (RDT) and thick film microscopy (TFM), and structured interviewer-administered questionnaires. Associations between weighted P. falciparum malaria prevalence (pfPR), based on RDT, and covariates were estimated as odds... (More)

Background: Plasmodium falciparum malaria is an important cause of morbidity in northern Uganda. This study was undertaken to assess village-, household-, and individual-level risk factors of asymptomatic falciparum malaria in children in 12 villages in northern Uganda. Methods: Between 10/2011 and 02/2014, 1006 apparently healthy children under 16 years old were enrolled in 12 villages using a stratified, multi-stage, cluster survey design and assessed for P. falciparum malaria infection using the rapid diagnostic test (RDT) and thick film microscopy (TFM), and structured interviewer-administered questionnaires. Associations between weighted P. falciparum malaria prevalence (pfPR), based on RDT, and covariates were estimated as odds ratios and 95% confidence intervals (ORs, 95% CIs) using logistic models accounting for the survey design. Results: Among 942 (93.5%) children successfully tested, pfPR was 52.4% by RDT and 32.7% by TFM. Overall pfPR was lower in villages where indoor residual insecticide spray (IRS) was, versus not, implemented (18.4% versus 75.2%, P < 0.0001). However, pfPR was heterogeneous both within IRS (10.6-34.8%) and non-IRS villages (63.6-86.2%). Elevated pfPR was associated with having a sibling who was RDT positive (OR 5.39, 95% CI 2.94-9.90, P = 0.0006) and reporting a fever at enrollment (aOR 4.80, 95% CI 1.94-11.9, P = 0.0094). Decreased pfPR was associated with living in an IRS village (adjusted OR 0.06, 95% CI 0.04-0.07, P < 0.0001), in a household with one (aOR 0.48, 95% CI 0.30-0.76) or more than one child below 5 years (aOR 0.23, 95% CI 0.12-0.44, Ptrend = 0.014), and reporting keeping a goat inside or near the house (aOR 0.42, 95% CI 0.29-0.62, P = 0.0021). Conclusions: The results show high but heterogeneous pfPR in villages in northern Uganda, confirm significantly decreased pfPR associated with IRS implementation, and suggest significant associations with some household characteristics. Further research is needed to elucidate the factors influencing malaria heterogeneity in villages in Uganda.

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published
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keywords
Africa, Burkitt lymphoma, Epidemiology, Malaria, Non-Hodgkin lymphoma, Plasmodium falciparum, Uganda
in
Malaria Journal
volume
17
issue
1
publisher
BioMed Central
external identifiers
  • scopus:85048769408
ISSN
1475-2875
DOI
10.1186/s12936-018-2379-1
language
English
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no
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96ee32cd-c1be-4f4a-ad4e-b7ea0f9cc16e
date added to LUP
2019-08-05 11:47:36
date last changed
2019-11-13 05:39:41
@article{96ee32cd-c1be-4f4a-ad4e-b7ea0f9cc16e,
  abstract     = {<p>Background: Plasmodium falciparum malaria is an important cause of morbidity in northern Uganda. This study was undertaken to assess village-, household-, and individual-level risk factors of asymptomatic falciparum malaria in children in 12 villages in northern Uganda. Methods: Between 10/2011 and 02/2014, 1006 apparently healthy children under 16 years old were enrolled in 12 villages using a stratified, multi-stage, cluster survey design and assessed for P. falciparum malaria infection using the rapid diagnostic test (RDT) and thick film microscopy (TFM), and structured interviewer-administered questionnaires. Associations between weighted P. falciparum malaria prevalence (pfPR), based on RDT, and covariates were estimated as odds ratios and 95% confidence intervals (ORs, 95% CIs) using logistic models accounting for the survey design. Results: Among 942 (93.5%) children successfully tested, pfPR was 52.4% by RDT and 32.7% by TFM. Overall pfPR was lower in villages where indoor residual insecticide spray (IRS) was, versus not, implemented (18.4% versus 75.2%, P &lt; 0.0001). However, pfPR was heterogeneous both within IRS (10.6-34.8%) and non-IRS villages (63.6-86.2%). Elevated pfPR was associated with having a sibling who was RDT positive (OR 5.39, 95% CI 2.94-9.90, P = 0.0006) and reporting a fever at enrollment (aOR 4.80, 95% CI 1.94-11.9, P = 0.0094). Decreased pfPR was associated with living in an IRS village (adjusted OR 0.06, 95% CI 0.04-0.07, P &lt; 0.0001), in a household with one (aOR 0.48, 95% CI 0.30-0.76) or more than one child below 5 years (aOR 0.23, 95% CI 0.12-0.44, P<sub>trend</sub> = 0.014), and reporting keeping a goat inside or near the house (aOR 0.42, 95% CI 0.29-0.62, P = 0.0021). Conclusions: The results show high but heterogeneous pfPR in villages in northern Uganda, confirm significantly decreased pfPR associated with IRS implementation, and suggest significant associations with some household characteristics. Further research is needed to elucidate the factors influencing malaria heterogeneity in villages in Uganda.</p>},
  articleno    = {240},
  author       = {Maziarz, Marlena and Nabalende, Hadijah and Otim, Isaac and Legason, Ismail D. and Kinyera, Tobias and Ogwang, Martin D. and Talisuna, Ambrose O. and Reynolds, Steven J. and Kerchan, Patrick and Bhatia, Kishor and Biggar, Robert J. and Goedert, James J. and Pfeiffer, Ruth M. and Mbulaiteye, Sam M.},
  issn         = {1475-2875},
  keyword      = {Africa,Burkitt lymphoma,Epidemiology,Malaria,Non-Hodgkin lymphoma,Plasmodium falciparum,Uganda},
  language     = {eng},
  month        = {06},
  number       = {1},
  publisher    = {BioMed Central},
  series       = {Malaria Journal},
  title        = {A cross-sectional study of asymptomatic Plasmodium falciparum infection burden and risk factors in general population children in 12 villages in northern Uganda},
  url          = {http://dx.doi.org/10.1186/s12936-018-2379-1},
  volume       = {17},
  year         = {2018},
}