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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Effect of a fall in malaria transmission on morbidity and mortality in Kilifi, Kenya
The Lancet, Volume 372, No. 9649, Year 2008
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Description
Background: As efforts to control malaria are expanded across the world, understanding the role of transmission intensity in determining the burden of clinical malaria is crucial to the prediction and measurement of the effectiveness of interventions to reduce transmission. Furthermore, studies comparing several endemic sites led to speculation that as transmission decreases morbidity and mortality caused by severe malaria might increase. We aimed to assess the epidemiological characteristics of malaria in Kilifi, Kenya, during a period of decreasing transmission intensity. Methods: We analyse 18 years (1990-2007) of surveillance data from a paediatric ward in a malaria-endemic region of Kenya. The hospital has a catchment area of 250 000 people. Clinical data and blood-film results for more than 61 000 admissions are reported. Findings: Hospital admissions for malaria decreased from 18·43 per 1000 children in 2003 to 3·42 in 2007. Over 18 years of surveillance, the incidence of cerebral malaria initially increased; however, malaria mortality decreased overall because of a decrease in incidence of severe malarial anaemia since 1997 (4·75 to 0·37 per 1000 children) and improved survival among children admitted with non-severe malaria. Parasite prevalence, the mean age of children admitted with malaria, and the proportion of children with cerebral malaria began to change 10 years before hospitalisation for malaria started to fall. Interpretation: Sustained reduction in exposure to infection leads to changes in mean age and presentation of disease similar to those described in multisite studies. Changes in transmission might not lead to immediate reductions in incidence of clinical disease. However, longitudinal data do not indicate that reductions in transmission intensity lead to transient increases in morbidity and mortality. Funding: Wellcome Trust, Kenya Medical Research Institute. © 2008 Elsevier Ltd. All rights reserved.
Authors & Co-Authors
O'Meara, Wendy Prudhomme
Kenya, Kilifi
Centre for Geographic Medicine Research
United States, Bethesda
Fogarty International Center
Bejon, Philip A.
Kenya, Kilifi
Centre for Geographic Medicine Research
United Kingdom, Oxford
Nuffield Department of Medicine
Mwangi, Tabitha Wanja
Kenya, Kilifi
Centre for Geographic Medicine Research
Okiro, Emelda Aluoch
Kenya, Nairobi
Kenya Medical Research Institute
Peshu, Norbert M.
Kenya, Kilifi
Centre for Geographic Medicine Research
Snow, Robert William
Kenya, Nairobi
Kenya Medical Research Institute
United Kingdom, Oxford
Nuffield Department of Medicine
Newton, Charles R.J.C.
Kenya, Kilifi
Centre for Geographic Medicine Research
United Kingdom, London
Ucl Great Ormond Street Institute of Child Health
Marsh, Kevin
Kenya, Kilifi
Centre for Geographic Medicine Research
United Kingdom, Oxford
Nuffield Department of Medicine
Statistics
Citations: 478
Authors: 8
Affiliations: 5
Identifiers
Doi:
10.1016/S0140-6736(08)61655-4
ISSN:
01406736
Research Areas
Health System And Policy
Infectious Diseases
Maternal And Child Health
Study Design
Cross Sectional Study
Cohort Study
Study Locations
Kenya