Abstract
BackgroundPlasmodium falciparum malaria is an important cause of morbidity in northern Uganda. This study was undertaken to assess village-, household-, and individual-level risk factors of asymptomatic falciparum malaria in children in 12 villages in northern Uganda.MethodsBetween 10/2011 and 02/2014, 1006 apparently healthy children under 16 years old were enrolled in 12 villages using a stratified, multi-stage, cluster survey design and assessed for P. falciparum malaria infection using the rapid diagnostic test (RDT) and thick film microscopy (TFM), and structured interviewer-administered questionnaires. Associations between weighted P. falciparum malaria prevalence (pfPR), based on RDT, and covariates were estimated as odds ratios and 95% confidence intervals (ORs, 95% CIs) using logistic models accounting for the survey design.ResultsAmong 942 (93.5%) children successfully tested, pfPR was 52.4% by RDT and 32.7% by TFM. Overall pfPR was lower in villages where indoor residual insecticide spray (IRS) was, versus not, implemented (18.4% versus 75.2%, P < 0.0001). However, pfPR was heterogeneous both within IRS (10.6–34.8%) and non-IRS villages (63.6–86.2%). Elevated pfPR was associated with having a sibling who was RDT positive (OR 5.39, 95% CI 2.94–9.90, P = 0.0006) and reporting a fever at enrollment (aOR 4.80, 95% CI 1.94–11.9, P = 0.0094). Decreased pfPR was associated with living in an IRS village (adjusted OR 0.06, 95% CI 0.04–0.07, P < 0.0001), in a household with one (aOR 0.48, 95% CI 0.30–0.76) or more than one child below 5 years (aOR 0.23, 95% CI 0.12–0.44, Ptrend = 0.014), and reporting keeping a goat inside or near the house (aOR 0.42, 95% CI 0.29–0.62, P = 0.0021).ConclusionsThe results show high but heterogeneous pfPR in villages in northern Uganda, confirm significantly decreased pfPR associated with IRS implementation, and suggest significant associations with some household characteristics. Further research is needed to elucidate the factors influencing malaria heterogeneity in villages in Uganda.
Highlights
Plasmodium falciparum malaria is an important cause of morbidity in northern Uganda
Plasmodium falciparum malaria remains an important cause of morbidity and mortality globally, in children aged less than 5 years old in countries in subSaharan Africa [1, 2], including Uganda [3]
The weighted P. falciparum malaria prevalence (pfPR) was 52.4% by rapid diagnostic test (RDT) read by experienced local technicians and 32.7% (9.3– 56.2%) by thick film microscopy (TFM) performed by experienced local technicians (Table 1)
Summary
Plasmodium falciparum malaria is an important cause of morbidity in northern Uganda. This study was undertaken to assess village-, household-, and individual-level risk factors of asymptomatic falciparum malaria in children in 12 villages in northern Uganda. Plasmodium falciparum malaria remains an important cause of morbidity and mortality globally, in children aged less than 5 years old in countries in subSaharan Africa [1, 2], including Uganda [3]. The dramatic declines in outpatient malaria cases in children aged below 5 years old led to optimism that prompted withdrawal of IRS in 2014. This decision was premature because it was followed by a rapid increase of malaria cases [15]. This study was undertaken to obtain villagehousehold-, and individual-level information about risk factors of asymptomatic malaria infection in children in northern Uganda, which would complement data based on broad sampling at a national [14, 16] and regional levels [13].
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