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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
mathematics
Attributable fraction estimates and case definitions for malaria in endemic
Statistics in Medicine, Volume 13, No. 22, Year 1994
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Description
Asymptomatic carriage of malaria parasites occurs frequently in endemic areas and the detection of parasites in a blood film from a febrile individual does not necessarily indicate clinical malaria. In areas of low and moderate endemicity the parasite prevalence in fever cases can be compared with that in community controls to estimate the fraction of cases which are attributable to malaria. In areas of very high transmission such estimates of the attributable fraction may be imprecise because very few individuals are without parasites. Furthermore, non‐malarial fevers appear to suppress low levels of parasitaemia resulting in biased estimates of the attributable fraction. Alternative estimation techniques were therefore explored using data collected during 1989‐1991 from a highly endemic area of Tanzania, where over 80 per cent of young children are parasitaemic. Logistic regression methods which model fever risk as a continuous function of parasite density give more precise estimates than simple analyses of parasite prevalence and overcome problems of bias caused by the effects of non‐malarial fevers. Such models can be used to estimate the probability that any individual episode is malaria‐attributable and can be extended to allow for covariates. A case definition for symptomatic malaria that is used widely in endemic areas requires fever together with a parasite density above a specific cutoff. The choice of a cutoff value can be assisted by using the probabilities derived from the logistic model to estimate the sensitivity and specificity of the case definition. Copyright © 1994 John Wiley & Sons, Ltd.
Authors & Co-Authors
Smith, Thomas A.
Unknown Affiliation
Schellenberg, Joanna Armstrong
Unknown Affiliation
Hayes, Richard John
Unknown Affiliation
Statistics
Citations: 332
Authors: 3
Affiliations: 4
Identifiers
Doi:
10.1002/sim.4780132206
ISSN:
02776715
e-ISSN:
10970258
Research Areas
Infectious Diseases
Maternal And Child Health
Study Design
Cross Sectional Study
Study Locations
Tanzania