Abstract
Kenya is intensifying its national efforts in malaria control to achieve malaria elimination. Detailed characterization of malaria infection among populations living in the areas where the disease is endemic in Kenya is a crucial priority, especially for planning and evaluating future malaria elimination strategy. This study aimed to investigate the distribution and extent of malaria infection on islands in Lake Victoria of Kenya to aid in designing new interventions for malaria elimination. Five cross-sectional surveys were conducted between January 2012 and August 2014 on four islands (Mfangano, Takawiri, Kibuogi and Ngodhe) in Lake Victoria and a coastal mainland (Ungoye). Malaria prevalence varied significantly among settings: highest in Ungoye, followed by the large island of Mfangano and lowest in the three remaining small islands. Of the 3867 malaria infections detected by PCR, 91.8% were asymptomatic, 50.3% were sub-microscopic, of which 94% were also asymptomatic. We observed geographical differences and age dependency in both proportion of sub-microscopic infections and asymptomatic parasite carriage. Our findings highlighted the local heterogeneity in malaria prevalence on islands and a coastal area in Lake Victoria, and provided support for the inclusion of mass drug administration as a component of the intervention package to eliminate malaria on islands.
Highlights
Renewed international commitment to control malaria through scale-up of coverage of interventions reduced the prevalence of Plasmodium falciparum by half and the incidence of clinical disease by 40% in endemic Africa between 2000 and 20151
The present study is the first large-scale description of malaria prevalence on islands in Lake Victoria in Kenya based on both microscopy and PCR methods
The relative abundance of vector species and suitable larval habitats likely contribute to this variation in malaria prevalence between neighbouring islands and mainland in Lake Victoria
Summary
Renewed international commitment to control malaria through scale-up of coverage of interventions reduced the prevalence of Plasmodium falciparum by half and the incidence of clinical disease by 40% in endemic Africa between 2000 and 20151. Compared to Rusinga Island[9,10] and some mainland areas in the Lake Victoria basin where epidemiological studies have been conducted[11], there is a dearth of information on malaria endemicity on Mfangano and surrounding small islands. This cross-sectional study aimed to determine the prevalence and geographical distribution of malaria infections among populations on islands in Lake Victoria, Homa Bay County, Kenya. Results from this study provide baseline data for the ongoing plan to implement a malaria elimination package on islands and part of the mainland, where a short-term mass drug administration with ACT plus a small dose of primaquine is combined with sustained vector control with community engagement
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