Malaria transmission, infection, and disease at three sites with varied transmission intensity in Uganda: implications for malaria control

The intensification of control interventions has led to marked reductions in malaria burden in some settings, but not others. To provide a comprehensive description of malaria epidemiology in Uganda, we conducted surveillance studies over 24 months in 100 houses randomly selected from each of three...

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Published inThe American journal of tropical medicine and hygiene Vol. 92; no. 5; pp. 903 - 912
Main Authors Kamya, Moses R, Arinaitwe, Emmanuel, Wanzira, Humphrey, Katureebe, Agaba, Barusya, Chris, Kigozi, Simon P, Kilama, Maxwell, Tatem, Andrew J, Rosenthal, Philip J, Drakeley, Chris, Lindsay, Steve W, Staedke, Sarah G, Smith, David L, Greenhouse, Bryan, Dorsey, Grant
Format Journal Article
LanguageEnglish
Published United States The American Society of Tropical Medicine and Hygiene 01.05.2015
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Abstract The intensification of control interventions has led to marked reductions in malaria burden in some settings, but not others. To provide a comprehensive description of malaria epidemiology in Uganda, we conducted surveillance studies over 24 months in 100 houses randomly selected from each of three subcounties: Walukuba (peri-urban), Kihihi (rural), and Nagongera (rural). Annual entomological inoculation rate (aEIR) was estimated from monthly Centers for Disease Control and Prevention (CDC) light trap mosquito collections. Children aged 0.5-10 years were provided long-lasting insecticidal nets (LLINs) and followed for measures of parasite prevalence, anemia and malaria incidence. Estimates of aEIR were 2.8, 32.0, and 310 infectious bites per year, and estimates of parasite prevalence 7.4%, 9.3%, and 28.7% for Walukuba, Kihihi, and Nagongera, respectively. Over the 2-year study, malaria incidence per person-years decreased in Walukuba (0.51 versus 0.31, P = 0.001) and increased in Kihihi (0.97 versus 1.93, P < 0.001) and Nagongera (2.33 versus 3.30, P < 0.001). Of 2,582 episodes of malaria, only 8 (0.3%) met criteria for severe disease. The prevalence of anemia was low and not associated with transmission intensity. In our cohorts, where LLINs and prompt effective treatment were provided, the risk of complicated malaria and anemia was extremely low. However, malaria incidence was high and increased over time at the two rural sites, suggesting improved community-wide coverage of LLIN and additional malaria control interventions are needed in Uganda.
AbstractList The intensification of control interventions has led to marked reductions in malaria burden in some settings, but not others. To provide a comprehensive description of malaria epidemiology in Uganda, we conducted surveillance studies over 24 months in 100 houses randomly selected from each of three subcounties: Walukuba (peri-urban), Kihihi (rural), and Nagongera (rural). Annual entomological inoculation rate (aEIR) was estimated from monthly Centers for Disease Control and Prevention (CDC) light trap mosquito collections. Children aged 0.5-10 years were provided long-lasting insecticidal nets (LLINs) and followed for measures of parasite prevalence, anemia and malaria incidence. Estimates of aEIR were 2.8, 32.0, and 310 infectious bites per year, and estimates of parasite prevalence 7.4%, 9.3%, and 28.7% for Walukuba, Kihihi, and Nagongera, respectively. Over the 2-year study, malaria incidence per person-years decreased in Walukuba (0.51 versus 0.31, P = 0.001) and increased in Kihihi (0.97 versus 1.93, P &lt; 0.001) and Nagongera (2.33 versus 3.30, P &lt; 0.001). Of 2,582 episodes of malaria, only 8 (0.3%) met criteria for severe disease. The prevalence of anemia was low and not associated with transmission intensity. In our cohorts, where LLINs and prompt effective treatment were provided, the risk of complicated malaria and anemia was extremely low. However, malaria incidence was high and increased over time at the two rural sites, suggesting improved community-wide coverage of LLIN and additional malaria control interventions are needed in Uganda.
The intensification of control interventions has led to marked reductions in malaria burden in some settings, but not others. To provide a comprehensive description of malaria epidemiology in Uganda, we conducted surveillance studies over 24 months in 100 houses randomly selected from each of three subcounties: Walukuba (peri-urban), Kihihi (rural), and Nagongera (rural). Annual entomological inoculation rate (aEIR) was estimated from monthly Centers for Disease Control and Prevention (CDC) light trap mosquito collections. Children aged 0.5-10 years were provided long-lasting insecticidal nets (LLINs) and followed for measures of parasite prevalence, anemia and malaria incidence. Estimates of aEIR were 2.8, 32.0, and 310 infectious bites per year, and estimates of parasite prevalence 7.4%, 9.3%, and 28.7% for Walukuba, Kihihi, and Nagongera, respectively. Over the 2-year study, malaria incidence per person-years decreased in Walukuba (0.51 versus 0.31, P = 0.001) and increased in Kihihi (0.97 versus 1.93, P < 0.001) and Nagongera (2.33 versus 3.30, P < 0.001). Of 2,582 episodes of malaria, only 8 (0.3%) met criteria for severe disease. The prevalence of anemia was low and not associated with transmission intensity. In our cohorts, where LLINs and prompt effective treatment were provided, the risk of complicated malaria and anemia was extremely low. However, malaria incidence was high and increased over time at the two rural sites, suggesting improved community-wide coverage of LLIN and additional malaria control interventions are needed in Uganda.
The intensification of control interventions has led to marked reductions in malaria burden in some settings, but not others. To provide a comprehensive description of malaria epidemiology in Uganda, we conducted surveillance studies over 24 months in 100 houses randomly selected from each of three subcounties: Walukuba (peri-urban), Kihihi (rural), and Nagongera (rural). Annual entomological inoculation rate (aEIR) was estimated from monthly Centers for Disease Control and Prevention (CDC) light trap mosquito collections. Children aged 0.5–10 years were provided long-lasting insecticidal nets (LLINs) and followed for measures of parasite prevalence, anemia and malaria incidence. Estimates of aEIR were 2.8, 32.0, and 310 infectious bites per year, and estimates of parasite prevalence 7.4%, 9.3%, and 28.7% for Walukuba, Kihihi, and Nagongera, respectively. Over the 2-year study, malaria incidence per person-years decreased in Walukuba (0.51 versus 0.31, P = 0.001) and increased in Kihihi (0.97 versus 1.93, P < 0.001) and Nagongera (2.33 versus 3.30, P < 0.001). Of 2,582 episodes of malaria, only 8 (0.3%) met criteria for severe disease. The prevalence of anemia was low and not associated with transmission intensity. In our cohorts, where LLINs and prompt effective treatment were provided, the risk of complicated malaria and anemia was extremely low. However, malaria incidence was high and increased over time at the two rural sites, suggesting improved community-wide coverage of LLIN and additional malaria control interventions are needed in Uganda.
The intensification of control interventions has led to marked reductions in malaria burden in some settings, but not others. To provide a comprehensive description of malaria epidemiology in Uganda, we conducted surveillance studies over 24 months in 100 houses randomly selected from each of three subcounties: Walukuba (peri-urban), Kihihi (rural), and Nagongera (rural). Annual entomological inoculation rate (aEIR) was estimated from monthly Centers for Disease Control and Prevention (CDC) light trap mosguito collections. Children aged 0.5-10 years were provided long-lasting insecticidal nets (LLINs) and followed for measures of parasite prevalence, anemia and malaria incidence. Estimates of aEIR were 2.8, 32.0, and 310 infectious bites per year, and estimates of parasite prevalence 7.4%, 9.3%, and 28.7% for Walukuba, Kihihi, and Nagongera, respectively. Over the 2-year study, malaria incidence per person-years decreased in Walukuba (0.51 versus 0.31, P = 0.001) and increased in Kihihi (0.97 versus 1.93, P < 0.001) and Nagongera (2.33 versus 3.30, P < 0.001). Of 2,582 episodes of malaria, only 8 (0.3%) met criteria for severe disease. The prevalence of anemia was low and not associated with transmission intensity. In our cohorts, where LLINs and prompt effective treatment were provided, the risk of complicated malaria and anemia was extremely low. However, malaria incidence was high and increased over time at the two rural sites, suggesting improved community-wide coverage of LLIN and additional malaria control interventions are needed in Uganda.
Author Barusya, Chris
Rosenthal, Philip J
Katureebe, Agaba
Tatem, Andrew J
Smith, David L
Lindsay, Steve W
Arinaitwe, Emmanuel
Staedke, Sarah G
Dorsey, Grant
Greenhouse, Bryan
Wanzira, Humphrey
Kigozi, Simon P
Drakeley, Chris
Kamya, Moses R
Kilama, Maxwell
AuthorAffiliation Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda; Department of Geography and Environment, University of Southampton, Southampton, United Kingdom; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; London School of Hygiene and Tropical Medicine, London, United Kingdom; School of Biological and Biomedical Sciences, Durham University, Durham, United Kingdom; Department of Zoology, University of Oxford, United Kingdom; Sanaria Institute for Global Health and Tropical Medicine, Rockville, Maryland
AuthorAffiliation_xml – name: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda; Department of Geography and Environment, University of Southampton, Southampton, United Kingdom; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; London School of Hygiene and Tropical Medicine, London, United Kingdom; School of Biological and Biomedical Sciences, Durham University, Durham, United Kingdom; Department of Zoology, University of Oxford, United Kingdom; Sanaria Institute for Global Health and Tropical Medicine, Rockville, Maryland
Author_xml – sequence: 1
  givenname: Moses R
  surname: Kamya
  fullname: Kamya, Moses R
  email: mkamya@infocom.co.ug
  organization: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda; Department of Geography and Environment, University of Southampton, Southampton, United Kingdom; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; London School of Hygiene and Tropical Medicine, London, United Kingdom; School of Biological and Biomedical Sciences, Durham University, Durham, United Kingdom; Department of Zoology, University of Oxford, United Kingdom; Sanaria Institute for Global Health and Tropical Medicine, Rockville, Maryland mkamya@infocom.co.ug
– sequence: 2
  givenname: Emmanuel
  surname: Arinaitwe
  fullname: Arinaitwe, Emmanuel
  organization: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda; Department of Geography and Environment, University of Southampton, Southampton, United Kingdom; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; London School of Hygiene and Tropical Medicine, London, United Kingdom; School of Biological and Biomedical Sciences, Durham University, Durham, United Kingdom; Department of Zoology, University of Oxford, United Kingdom; Sanaria Institute for Global Health and Tropical Medicine, Rockville, Maryland
– sequence: 3
  givenname: Humphrey
  surname: Wanzira
  fullname: Wanzira, Humphrey
  organization: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda; Department of Geography and Environment, University of Southampton, Southampton, United Kingdom; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; London School of Hygiene and Tropical Medicine, London, United Kingdom; School of Biological and Biomedical Sciences, Durham University, Durham, United Kingdom; Department of Zoology, University of Oxford, United Kingdom; Sanaria Institute for Global Health and Tropical Medicine, Rockville, Maryland
– sequence: 4
  givenname: Agaba
  surname: Katureebe
  fullname: Katureebe, Agaba
  organization: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda; Department of Geography and Environment, University of Southampton, Southampton, United Kingdom; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; London School of Hygiene and Tropical Medicine, London, United Kingdom; School of Biological and Biomedical Sciences, Durham University, Durham, United Kingdom; Department of Zoology, University of Oxford, United Kingdom; Sanaria Institute for Global Health and Tropical Medicine, Rockville, Maryland
– sequence: 5
  givenname: Chris
  surname: Barusya
  fullname: Barusya, Chris
  organization: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda; Department of Geography and Environment, University of Southampton, Southampton, United Kingdom; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; London School of Hygiene and Tropical Medicine, London, United Kingdom; School of Biological and Biomedical Sciences, Durham University, Durham, United Kingdom; Department of Zoology, University of Oxford, United Kingdom; Sanaria Institute for Global Health and Tropical Medicine, Rockville, Maryland
– sequence: 6
  givenname: Simon P
  surname: Kigozi
  fullname: Kigozi, Simon P
  organization: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda; Department of Geography and Environment, University of Southampton, Southampton, United Kingdom; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; London School of Hygiene and Tropical Medicine, London, United Kingdom; School of Biological and Biomedical Sciences, Durham University, Durham, United Kingdom; Department of Zoology, University of Oxford, United Kingdom; Sanaria Institute for Global Health and Tropical Medicine, Rockville, Maryland
– sequence: 7
  givenname: Maxwell
  surname: Kilama
  fullname: Kilama, Maxwell
  organization: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda; Department of Geography and Environment, University of Southampton, Southampton, United Kingdom; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; London School of Hygiene and Tropical Medicine, London, United Kingdom; School of Biological and Biomedical Sciences, Durham University, Durham, United Kingdom; Department of Zoology, University of Oxford, United Kingdom; Sanaria Institute for Global Health and Tropical Medicine, Rockville, Maryland
– sequence: 8
  givenname: Andrew J
  surname: Tatem
  fullname: Tatem, Andrew J
  organization: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda; Department of Geography and Environment, University of Southampton, Southampton, United Kingdom; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; London School of Hygiene and Tropical Medicine, London, United Kingdom; School of Biological and Biomedical Sciences, Durham University, Durham, United Kingdom; Department of Zoology, University of Oxford, United Kingdom; Sanaria Institute for Global Health and Tropical Medicine, Rockville, Maryland
– sequence: 9
  givenname: Philip J
  surname: Rosenthal
  fullname: Rosenthal, Philip J
  organization: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda; Department of Geography and Environment, University of Southampton, Southampton, United Kingdom; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; London School of Hygiene and Tropical Medicine, London, United Kingdom; School of Biological and Biomedical Sciences, Durham University, Durham, United Kingdom; Department of Zoology, University of Oxford, United Kingdom; Sanaria Institute for Global Health and Tropical Medicine, Rockville, Maryland
– sequence: 10
  givenname: Chris
  surname: Drakeley
  fullname: Drakeley, Chris
  organization: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda; Department of Geography and Environment, University of Southampton, Southampton, United Kingdom; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; London School of Hygiene and Tropical Medicine, London, United Kingdom; School of Biological and Biomedical Sciences, Durham University, Durham, United Kingdom; Department of Zoology, University of Oxford, United Kingdom; Sanaria Institute for Global Health and Tropical Medicine, Rockville, Maryland
– sequence: 11
  givenname: Steve W
  surname: Lindsay
  fullname: Lindsay, Steve W
  organization: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda; Department of Geography and Environment, University of Southampton, Southampton, United Kingdom; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; London School of Hygiene and Tropical Medicine, London, United Kingdom; School of Biological and Biomedical Sciences, Durham University, Durham, United Kingdom; Department of Zoology, University of Oxford, United Kingdom; Sanaria Institute for Global Health and Tropical Medicine, Rockville, Maryland
– sequence: 12
  givenname: Sarah G
  surname: Staedke
  fullname: Staedke, Sarah G
  organization: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda; Department of Geography and Environment, University of Southampton, Southampton, United Kingdom; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; London School of Hygiene and Tropical Medicine, London, United Kingdom; School of Biological and Biomedical Sciences, Durham University, Durham, United Kingdom; Department of Zoology, University of Oxford, United Kingdom; Sanaria Institute for Global Health and Tropical Medicine, Rockville, Maryland
– sequence: 13
  givenname: David L
  surname: Smith
  fullname: Smith, David L
  organization: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda; Department of Geography and Environment, University of Southampton, Southampton, United Kingdom; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; London School of Hygiene and Tropical Medicine, London, United Kingdom; School of Biological and Biomedical Sciences, Durham University, Durham, United Kingdom; Department of Zoology, University of Oxford, United Kingdom; Sanaria Institute for Global Health and Tropical Medicine, Rockville, Maryland
– sequence: 14
  givenname: Bryan
  surname: Greenhouse
  fullname: Greenhouse, Bryan
  organization: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda; Department of Geography and Environment, University of Southampton, Southampton, United Kingdom; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; London School of Hygiene and Tropical Medicine, London, United Kingdom; School of Biological and Biomedical Sciences, Durham University, Durham, United Kingdom; Department of Zoology, University of Oxford, United Kingdom; Sanaria Institute for Global Health and Tropical Medicine, Rockville, Maryland
– sequence: 15
  givenname: Grant
  surname: Dorsey
  fullname: Dorsey, Grant
  organization: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda; Department of Geography and Environment, University of Southampton, Southampton, United Kingdom; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; London School of Hygiene and Tropical Medicine, London, United Kingdom; School of Biological and Biomedical Sciences, Durham University, Durham, United Kingdom; Department of Zoology, University of Oxford, United Kingdom; Sanaria Institute for Global Health and Tropical Medicine, Rockville, Maryland
BackLink https://www.ncbi.nlm.nih.gov/pubmed/25778501$$D View this record in MEDLINE/PubMed
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Cites_doi 10.1016/B978-0-12-800099-1.00003-X
ContentType Journal Article
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Snippet The intensification of control interventions has led to marked reductions in malaria burden in some settings, but not others. To provide a comprehensive...
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SubjectTerms Anemia - drug therapy
Anemia - epidemiology
Animals
Child
Child, Preschool
Cohort Studies
Culicidae - parasitology
Female
Geography
Humans
Incidence
Infant
Insect Bites and Stings
Insect Vectors - parasitology
Insecticide-Treated Bednets
Malaria - drug therapy
Malaria - epidemiology
Malaria - prevention & control
Malaria - transmission
Male
Mosquito Control
Prevalence
Prospective Studies
Rural Population
Uganda - epidemiology
Title Malaria transmission, infection, and disease at three sites with varied transmission intensity in Uganda: implications for malaria control
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