Abstract
BackgroundThe use of malaria infection prevalence among febrile patients at clinics has a potential to be a valuable epidemiological surveillance tool. However, routine data are incomplete and not all fevers are tested. This study was designed to screen all fevers for malaria infection in Kenya to explore the epidemiology of fever test positivity rates.MethodsRandom sampling was used within five malaria epidemiological zones of Kenya (i.e., high lake endemic, moderate coast endemic, highland epidemic, seasonal low transmission and low risk zones). The selected sample was representative of the number of hospitals, health centres and dispensaries within each zone. Fifty patients with fever presenting to each sampled health facility during the short rainy season were screened for malaria infection using a rapid diagnostic test (RDT). Details of age, pregnancy status and basic demographics were recorded for each patient screened.Results10,557 febrile patients presenting to out-patient clinics at 234 health facilities were screened for malaria infection. 1633 (15.5%) of the patients surveyed were RDT positive for malaria at 124 (53.0%) facilities. Infection prevalence among non-pregnant patients varied between malaria risk zones, ranging from 0.6% in the low risk zone to 41.6% in the high lake endemic zone. Test positivity rates (TPR) by age group reflected the differences in the intensity of transmission between epidemiological zones. In the lake endemic zone, 6% of all infections were among children aged less than 1 year, compared to 3% in the coast endemic, 1% in the highland epidemic zone, less than 1% in the seasonal low transmission zone and 0% in the low risk zone. Test positivity rate was 31% among febrile pregnant women in the high lake endemic zone compared to 9% in the coast endemic and highland epidemic zones, 3.2% in the seasonal low transmission zone and zero in the low risk zone.ConclusionMalaria infection rates among febrile patients, with supporting data on age and pregnancy status presenting to clinics in Kenya can provide invaluable epidemiological data on spatial heterogeneity of malaria and serve as replacements to more expensive community-based infection rates to plan and monitor malaria control.
Highlights
The use of malaria infection prevalence among febrile patients at clinics has a potential to be a valuable epidemiological surveillance tool
In the lake endemic zone, 6% of all infections were among children aged less than 1 year, compared to 3% in the coast endemic and highland epidemic zone and less than 1% in the low risk zone and 0% in the exceptionally low risk zone (Table 2)
The present study was not designed to compare the direct congruence between fever test positivity rates (TPR) at health facilities and the prevalence of malaria infection among communities served by these facilities
Summary
The use of malaria infection prevalence among febrile patients at clinics has a potential to be a valuable epidemiological surveillance tool. Health facility-based surveys of malaria infection prevalence in febrile patients have been used as part of the rapid analysis of malaria risks in urban settings in Angola, [12] Mozambique [13], Burkina Faso, Benin, Tanzania and Côte d’Ivoire [14] They have been used as part of national surveys of malaria epidemiology in Niger [15] and The Gambia [16], and as a means to operationally measure intervention effectiveness through sentinel based case-control studies in Benin [17] and Madagascar [18]. The present study aimed to characterize the TPR of malaria in patients with reported fever presenting to clinics across Kenya to define the patterns of febrile infection rates nationwide as a potential epidemiological surveillance tool, not possible from routine data or from standard quality of care surveys.
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