Increasing incidence of malaria in children despite insecticide-treated bed nets and prompt anti-malarial therapy in Tororo, Uganda

Malaria Journal

Research

Frank Kaharuza¹  Moses R Kamya²  Grant Dorsey³  Prasanna Jagannathan³  Bryan Greenhouse³  Philip J Rosenthal³  Jordan Tappero⁴  Mary K Muhindo⁵  Emmanuel Arinaitwe⁵  Abel Kakuru⁵ 

[1] Centers for Disease Control and Prevention, Kampala, Uganda;Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda;Department of Medicine, San Francisco General Hospital, University of California, San Francisco, CA, USA;Global AIDS Program, Centers for Disease Control and Prevention, Atlanta, GA, USA;Infectious Diseases Research Collaboration, Kampala, Uganda;

关键词: Malaria;    Plasmodium falciparum;    Immunity;    Epidemiology;   

DOI  :  10.1186/1475-2875-11-435

 received in 2012-10-18, accepted in 2012-12-26,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundThe burden of malaria has decreased in parts of Africa following the scaling up of control interventions. However, similar data are limited from high transmission settings.MethodsA cohort of 100 children, aged six weeks to 10 months of age, were enrolled in an area of high malaria transmission intensity and followed through 48 months of age. Children were given a long-lasting insecticide-treated bed net (LLIN) at enrolment and received all care, including monthly blood smears and treatment with artemisinin-based combination therapy (ACT) for uncomplicated malaria, at a dedicated clinic. The incidence of malaria was estimated by passive surveillance and associations between malaria incidence and age, calendar time and season were measured using generalized estimating equations.ResultsReported compliance with LLINs was 98% based on monthly routine evaluations. A total of 1,633 episodes of malaria were observed, with a median incidence of 5.3 per person-year (PPY). There were only six cases of complicated malaria, all single convulsions. Malaria incidence peaked at 6.5 PPY at 23 months of age before declining to 3.5 PPY at 48 months. After adjusting for age and season, the risk of malaria increased by 52% from 2008 to 2011 (RR 1.52, 95% CI 1.10-2.09). Asymptomatic parasitaemia was uncommon (monthly prevalence <10%) and rarely observed prior to 24 months of age.ConclusionsIn Tororo, despite provision of LLINs and prompt treatment with ACT, the incidence of malaria is very high and appears to be rising. Additional malaria control interventions in high transmission settings are likely needed.Trial registrationCurrent Controlled Trials Identifier NCT00527800

【 授权许可】

CC BY   
© Jagannathan et al.; licensee BioMed Central Ltd. 2012