Longitudinal household surveillance for malaria in Rakai, Uganda

HIV and malaria exert co-pathogenic effects. Malaria surveillance data are necessary for public health strategies to reduce the burden of disease in high HIV prevalence settings. This was a longitudinal cohort study to assess the burden of malaria in rural Rakai, Uganda. Households were visited mont...

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Published inMalaria journal Vol. 15; no. 77; p. 77
Main Authors Newell, Kevin, Kiggundu, Valerian, Ouma, Joseph, Baghendage, Enos, Kiwanuka, Noah, Gray, Ronald, Serwadda, David, Hobbs, Charlotte V, Healy, Sara A, Quinn, Thomas C, Reynolds, Steven J
Format Journal Article
LanguageEnglish
Published England BioMed Central Ltd 09.02.2016
BioMed Central
Subjects
Adolescent
Adult
Analysis
Care and treatment
Child
Child, Preschool
Cohort Studies
Complications and side effects
Family Characteristics
Female
HIV Infections - epidemiology
Humans
Malaria
Malaria - epidemiology
Malaria - prevention & control
Male
Prevalence studies (Epidemiology)
Sentinel health events
Uganda - epidemiology
Young Adult
Uganda
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Abstract HIV and malaria exert co-pathogenic effects. Malaria surveillance data are necessary for public health strategies to reduce the burden of disease in high HIV prevalence settings. This was a longitudinal cohort study to assess the burden of malaria in rural Rakai, Uganda. Households were visited monthly for 1 year to identify confirmed clinical malaria (CCM), or parasitaemia with temperature >37.5 °C, and asymptomatic parasitaemia (AP). Interviews of the adult or child's caregiver and clinical and laboratory assessments were conducted. Rapid diagnostic testing for malaria and anaemia was performed if participants were febrile and anti-malarial treatment given per Uganda Ministry of Health 2010 guidelines. Blood was drawn at every household visit to assess for parasitaemia, and blood smears were assessed at the Rakai Health Science Programme laboratory. A total of 1640 participants were enrolled, including 975 children aged 6 months up to 10 years, 393 adult caregivers, and 272 adolescent/adult household members from 393 randomly selected households in two representative communities. 1459 (89 %) participants completed all study visits. CCM was identified in 304 (19 %) participants, with the highest incidence rate for CCM of 0.38 per person-year (ppy) identified in children <5 years, and rates decreased with age; the rates were 0.27, 0.16, and 0.09 ppy for ages 5-<10 years, 10-<18 years, and adults 18+ years, respectively. AP was identified in 943 (57 %) participants; the incidence rate was 1.99 ppy for <5 years, 2.72 ppy for 5-<10 years, 2.55 ppy for 10-<18 years, and 0.86 ppy among adults, with 92 % of cases being attributed to Plasmodium falciparum by smear. 994 (61 %) individuals had at least one positive smear; 342 (21 %) had one positive result, 203 (12 %) had two, 115 (7 %) had three, and 334 (21 %) had >3 positive smears during follow-up. Seasonal rates generally followed the rains and peaked during July, then decreased through November before increasing again. Plasmodium falciparum infection remains high in rural Uganda. Increased malaria control interventions should be prioritized. Trial registration Clinicaltrials.gov identifier NCT01265407.
AbstractList HIV and malaria exert co-pathogenic effects. Malaria surveillance data are necessary for public health strategies to reduce the burden of disease in high HIV prevalence settings.BACKGROUNDHIV and malaria exert co-pathogenic effects. Malaria surveillance data are necessary for public health strategies to reduce the burden of disease in high HIV prevalence settings.This was a longitudinal cohort study to assess the burden of malaria in rural Rakai, Uganda. Households were visited monthly for 1 year to identify confirmed clinical malaria (CCM), or parasitaemia with temperature >37.5 °C, and asymptomatic parasitaemia (AP). Interviews of the adult or child's caregiver and clinical and laboratory assessments were conducted. Rapid diagnostic testing for malaria and anaemia was performed if participants were febrile and anti-malarial treatment given per Uganda Ministry of Health 2010 guidelines. Blood was drawn at every household visit to assess for parasitaemia, and blood smears were assessed at the Rakai Health Science Programme laboratory.METHODSThis was a longitudinal cohort study to assess the burden of malaria in rural Rakai, Uganda. Households were visited monthly for 1 year to identify confirmed clinical malaria (CCM), or parasitaemia with temperature >37.5 °C, and asymptomatic parasitaemia (AP). Interviews of the adult or child's caregiver and clinical and laboratory assessments were conducted. Rapid diagnostic testing for malaria and anaemia was performed if participants were febrile and anti-malarial treatment given per Uganda Ministry of Health 2010 guidelines. Blood was drawn at every household visit to assess for parasitaemia, and blood smears were assessed at the Rakai Health Science Programme laboratory.A total of 1640 participants were enrolled, including 975 children aged 6 months up to 10 years, 393 adult caregivers, and 272 adolescent/adult household members from 393 randomly selected households in two representative communities. 1459 (89 %) participants completed all study visits. CCM was identified in 304 (19 %) participants, with the highest incidence rate for CCM of 0.38 per person-year (ppy) identified in children <5 years, and rates decreased with age; the rates were 0.27, 0.16, and 0.09 ppy for ages 5-<10 years, 10-<18 years, and adults 18+ years, respectively. AP was identified in 943 (57 %) participants; the incidence rate was 1.99 ppy for <5 years, 2.72 ppy for 5-<10 years, 2.55 ppy for 10-<18 years, and 0.86 ppy among adults, with 92 % of cases being attributed to Plasmodium falciparum by smear. 994 (61 %) individuals had at least one positive smear; 342 (21 %) had one positive result, 203 (12 %) had two, 115 (7 %) had three, and 334 (21 %) had >3 positive smears during follow-up. Seasonal rates generally followed the rains and peaked during July, then decreased through November before increasing again.RESULTSA total of 1640 participants were enrolled, including 975 children aged 6 months up to 10 years, 393 adult caregivers, and 272 adolescent/adult household members from 393 randomly selected households in two representative communities. 1459 (89 %) participants completed all study visits. CCM was identified in 304 (19 %) participants, with the highest incidence rate for CCM of 0.38 per person-year (ppy) identified in children <5 years, and rates decreased with age; the rates were 0.27, 0.16, and 0.09 ppy for ages 5-<10 years, 10-<18 years, and adults 18+ years, respectively. AP was identified in 943 (57 %) participants; the incidence rate was 1.99 ppy for <5 years, 2.72 ppy for 5-<10 years, 2.55 ppy for 10-<18 years, and 0.86 ppy among adults, with 92 % of cases being attributed to Plasmodium falciparum by smear. 994 (61 %) individuals had at least one positive smear; 342 (21 %) had one positive result, 203 (12 %) had two, 115 (7 %) had three, and 334 (21 %) had >3 positive smears during follow-up. Seasonal rates generally followed the rains and peaked during July, then decreased through November before increasing again.Plasmodium falciparum infection remains high in rural Uganda. Increased malaria control interventions should be prioritized. Trial registration Clinicaltrials.gov identifier NCT01265407.CONCLUSIONSPlasmodium falciparum infection remains high in rural Uganda. Increased malaria control interventions should be prioritized. Trial registration Clinicaltrials.gov identifier NCT01265407.
Background HIV and malaria exert co-pathogenic effects. Malaria surveillance data are necessary for public health strategies to reduce the burden of disease in high HIV prevalence settings. Methods This was a longitudinal cohort study to assess the burden of malaria in rural Rakai, Uganda. Households were visited monthly for 1 year to identify confirmed clinical malaria (CCM), or parasitaemia with temperature >37.5 °C, and asymptomatic parasitaemia (AP). Interviews of the adult or child's caregiver and clinical and laboratory assessments were conducted. Rapid diagnostic testing for malaria and anaemia was performed if participants were febrile and anti-malarial treatment given per Uganda Ministry of Health 2010 guidelines. Blood was drawn at every household visit to assess for parasitaemia, and blood smears were assessed at the Rakai Health Science Programme laboratory. Results A total of 1640 participants were enrolled, including 975 children aged 6 months up to 10 years, 393 adult caregivers, and 272 adolescent/adult household members from 393 randomly selected households in two representative communities. 1459 (89 %) participants completed all study visits. CCM was identified in 304 (19 %) participants, with the highest incidence rate for CCM of 0.38 per person-year (ppy) identified in children <5 years, and rates decreased with age; the rates were 0.27, 0.16, and 0.09 ppy for ages 5-<10 years, 10-<18 years, and adults 18+ years, respectively. AP was identified in 943 (57 %) participants; the incidence rate was 1.99 ppy for <5 years, 2.72 ppy for 5-<10 years, 2.55 ppy for 10-<18 years, and 0.86 ppy among adults, with 92 % of cases being attributed to Plasmodium falciparum by smear. 994 (61 %) individuals had at least one positive smear; 342 (21 %) had one positive result, 203 (12 %) had two, 115 (7 %) had three, and 334 (21 %) had >3 positive smears during follow-up. Seasonal rates generally followed the rains and peaked during July, then decreased through November before increasing again. Conclusions Plasmodium falciparum infection remains high in rural Uganda. Increased malaria control interventions should be prioritized.
HIV and malaria exert co-pathogenic effects. Malaria surveillance data are necessary for public health strategies to reduce the burden of disease in high HIV prevalence settings. This was a longitudinal cohort study to assess the burden of malaria in rural Rakai, Uganda. Households were visited monthly for 1 year to identify confirmed clinical malaria (CCM), or parasitaemia with temperature >37.5 °C, and asymptomatic parasitaemia (AP). Interviews of the adult or child's caregiver and clinical and laboratory assessments were conducted. Rapid diagnostic testing for malaria and anaemia was performed if participants were febrile and anti-malarial treatment given per Uganda Ministry of Health 2010 guidelines. Blood was drawn at every household visit to assess for parasitaemia, and blood smears were assessed at the Rakai Health Science Programme laboratory. A total of 1640 participants were enrolled, including 975 children aged 6 months up to 10 years, 393 adult caregivers, and 272 adolescent/adult household members from 393 randomly selected households in two representative communities. 1459 (89 %) participants completed all study visits. CCM was identified in 304 (19 %) participants, with the highest incidence rate for CCM of 0.38 per person-year (ppy) identified in children <5 years, and rates decreased with age; the rates were 0.27, 0.16, and 0.09 ppy for ages 5-<10 years, 10-<18 years, and adults 18+ years, respectively. AP was identified in 943 (57 %) participants; the incidence rate was 1.99 ppy for <5 years, 2.72 ppy for 5-<10 years, 2.55 ppy for 10-<18 years, and 0.86 ppy among adults, with 92 % of cases being attributed to Plasmodium falciparum by smear. 994 (61 %) individuals had at least one positive smear; 342 (21 %) had one positive result, 203 (12 %) had two, 115 (7 %) had three, and 334 (21 %) had >3 positive smears during follow-up. Seasonal rates generally followed the rains and peaked during July, then decreased through November before increasing again. Plasmodium falciparum infection remains high in rural Uganda. Increased malaria control interventions should be prioritized. Trial registration Clinicaltrials.gov identifier NCT01265407.
Background HIV and malaria exert co-pathogenic effects. Malaria surveillance data are necessary for public health strategies to reduce the burden of disease in high HIV prevalence settings. Methods This was a longitudinal cohort study to assess the burden of malaria in rural Rakai, Uganda. Households were visited monthly for 1 year to identify confirmed clinical malaria (CCM), or parasitaemia with temperature >37.5 °C, and asymptomatic parasitaemia (AP). Interviews of the adult or child's caregiver and clinical and laboratory assessments were conducted. Rapid diagnostic testing for malaria and anaemia was performed if participants were febrile and anti-malarial treatment given per Uganda Ministry of Health 2010 guidelines. Blood was drawn at every household visit to assess for parasitaemia, and blood smears were assessed at the Rakai Health Science Programme laboratory. Results A total of 1640 participants were enrolled, including 975 children aged 6 months up to 10 years, 393 adult caregivers, and 272 adolescent/adult household members from 393 randomly selected households in two representative communities. 1459 (89 %) participants completed all study visits. CCM was identified in 304 (19 %) participants, with the highest incidence rate for CCM of 0.38 per person-year (ppy) identified in children <5 years, and rates decreased with age; the rates were 0.27, 0.16, and 0.09 ppy for ages 5-<10 years, 10-<18 years, and adults 18+ years, respectively. AP was identified in 943 (57 %) participants; the incidence rate was 1.99 ppy for <5 years, 2.72 ppy for 5-<10 years, 2.55 ppy for 10-3 positive smears during follow-up. Seasonal rates generally followed the rains and peaked during July, then decreased through November before increasing again. Conclusions Plasmodium falciparum infection remains high in rural Uganda. Increased malaria control interventions should be prioritized. Trial registration Clinicaltrials.gov identifier NCT01265407 Keywords: Malaria, Epidemiology, Surveillance, Household, Children, Rakai, Africa
HIV and malaria exert co-pathogenic effects. Malaria surveillance data are necessary for public health strategies to reduce the burden of disease in high HIV prevalence settings. This was a longitudinal cohort study to assess the burden of malaria in rural Rakai, Uganda. Households were visited monthly for 1 year to identify confirmed clinical malaria (CCM), or parasitaemia with temperature >37.5 °C, and asymptomatic parasitaemia (AP). Interviews of the adult or child's caregiver and clinical and laboratory assessments were conducted. Rapid diagnostic testing for malaria and anaemia was performed if participants were febrile and anti-malarial treatment given per Uganda Ministry of Health 2010 guidelines. Blood was drawn at every household visit to assess for parasitaemia, and blood smears were assessed at the Rakai Health Science Programme laboratory. A total of 1640 participants were enrolled, including 975 children aged 6 months up to 10 years, 393 adult caregivers, and 272 adolescent/adult household members from 393 randomly selected households in two representative communities. 1459 (89 %) participants completed all study visits. CCM was identified in 304 (19 %) participants, with the highest incidence rate for CCM of 0.38 per person-year (ppy) identified in children <5 years, and rates decreased with age; the rates were 0.27, 0.16, and 0.09 ppy for ages 5-<10 years, 10-<18 years, and adults 18+ years, respectively. AP was identified in 943 (57 %) participants; the incidence rate was 1.99 ppy for <5 years, 2.72 ppy for 5-<10 years, 2.55 ppy for 10-3 positive smears during follow-up. Seasonal rates generally followed the rains and peaked during July, then decreased through November before increasing again. Plasmodium falciparum infection remains high in rural Uganda. Increased malaria control interventions should be prioritized.
ArticleNumber 77
Audience Academic
Author Kiggundu, Valerian
Kiwanuka, Noah
Quinn, Thomas C
Ouma, Joseph
Baghendage, Enos
Serwadda, David
Healy, Sara A
Reynolds, Steven J
Hobbs, Charlotte V
Newell, Kevin
Gray, Ronald
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  givenname: Charlotte V
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PublicationPlace_xml – name: England
– name: London
PublicationTitle Malaria journal
PublicationTitleAlternate Malar J
PublicationYear 2016
Publisher BioMed Central Ltd
BioMed Central
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References Uganda Bureau of Statistics (UBOS) and ICF Macro (1128_CR1) 2010
T Bousema (1128_CR17) 2014; 12
MJ Wawer (1128_CR9) 1999; 353
SC Murphy (1128_CR16) 2013; 89
L Kish (1128_CR10) 1949; 44
Uganda Ministry of Health (1128_CR2) 2011
V D’Acremont (1128_CR18) 2014; 370
1128_CR8
JR Ryan (1128_CR14) 2006; 75
1128_CR5
S Malamba (1128_CR4) 2007; 6
MK Grabowski (1128_CR7) 2014; 11
S Hulley (1128_CR13) 2001
1128_CR3
G Pasvol (1128_CR15) 2007; 101
VL Kiggundu (1128_CR6) 2013; 8
1128_CR11
1128_CR12
References_xml – volume-title: Designing clinical research
  year: 2001
  ident: 1128_CR13
  contributor:
    fullname: S Hulley
– volume-title: Uganda Malaria programme review report 2001–2010
  year: 2011
  ident: 1128_CR2
  contributor:
    fullname: Uganda Ministry of Health
– volume: 11
  start-page: e1001610
  year: 2014
  ident: 1128_CR7
  publication-title: PLoS Med
  doi: 10.1371/journal.pmed.1001610
  contributor:
    fullname: MK Grabowski
– volume: 89
  start-page: 824
  year: 2013
  ident: 1128_CR16
  publication-title: Am J Trop Med Hyg
  doi: 10.4269/ajtmh.12-0675
  contributor:
    fullname: SC Murphy
– ident: 1128_CR12
– volume: 353
  start-page: 525
  year: 1999
  ident: 1128_CR9
  publication-title: Lancet
  doi: 10.1016/S0140-6736(98)06439-3
  contributor:
    fullname: MJ Wawer
– ident: 1128_CR11
– volume: 101
  start-page: 953
  year: 2007
  ident: 1128_CR15
  publication-title: Trans R Soc Trop Med Hyg
  doi: 10.1016/j.trstmh.2007.05.007
  contributor:
    fullname: G Pasvol
– volume: 370
  start-page: 809
  year: 2014
  ident: 1128_CR18
  publication-title: N Engl J Med
  doi: 10.1056/NEJMoa1214482
  contributor:
    fullname: V D’Acremont
– volume: 8
  start-page: e82455
  year: 2013
  ident: 1128_CR6
  publication-title: PLoS One
  doi: 10.1371/journal.pone.0082455
  contributor:
    fullname: VL Kiggundu
– volume: 12
  start-page: 833
  year: 2014
  ident: 1128_CR17
  publication-title: Nat Rev Microbiol
  doi: 10.1038/nrmicro3364
  contributor:
    fullname: T Bousema
– volume: 75
  start-page: 575
  year: 2006
  ident: 1128_CR14
  publication-title: Am J Trop Med Hyg
  doi: 10.4269/ajtmh.2006.75.575
  contributor:
    fullname: JR Ryan
– ident: 1128_CR3
– ident: 1128_CR8
– volume-title: Uganda Malaria Indicator Survey 2009
  year: 2010
  ident: 1128_CR1
  contributor:
    fullname: Uganda Bureau of Statistics (UBOS) and ICF Macro
– volume: 6
  start-page: 143
  year: 2007
  ident: 1128_CR4
  publication-title: Malar J.
  doi: 10.1186/1475-2875-6-143
  contributor:
    fullname: S Malamba
– ident: 1128_CR5
– volume: 44
  start-page: 380
  year: 1949
  ident: 1128_CR10
  publication-title: J Am Stat Assoc
  doi: 10.1080/01621459.1949.10483314
  contributor:
    fullname: L Kish
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Snippet HIV and malaria exert co-pathogenic effects. Malaria surveillance data are necessary for public health strategies to reduce the burden of disease in high HIV...
Background HIV and malaria exert co-pathogenic effects. Malaria surveillance data are necessary for public health strategies to reduce the burden of disease in...
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SubjectTerms Adolescent
Adult
Analysis
Care and treatment
Child
Child, Preschool
Cohort Studies
Complications and side effects
Family Characteristics
Female
HIV Infections - epidemiology
Humans
Malaria
Malaria - epidemiology
Malaria - prevention & control
Male
Prevalence studies (Epidemiology)
Sentinel health events
Uganda - epidemiology
Young Adult
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Title Longitudinal household surveillance for malaria in Rakai, Uganda
URI https://www.ncbi.nlm.nih.gov/pubmed/26861943
https://www.proquest.com/docview/1798361479/abstract/
https://www.proquest.com/docview/1764698395/abstract/
https://pubmed.ncbi.nlm.nih.gov/PMC4746783
Volume 15
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