Abstract
The relationship between community prevalence of Plasmodium falciparum and the burden of severe, life-threatening disease remains poorly defined. To examine the three most common severe malaria phenotypes from catchment populations across East Africa, we assembled a dataset of 6506 malaria admissions in children aged 3 months to 9 years from 2006 to 2020. Admissions were paired with data from community parasite infection surveys. A Bayesian procedure was used to calibrate uncertainties in exposure (parasite prevalence) and outcomes (severe malaria phenotypes). Each 25% increase in prevalence conferred a doubling of severe malaria admission rates. Severe malaria remains a burden predominantly among young children (3 to 59 months) across a wide range of community prevalence typical of East Africa. This study offers a quantitative framework for linking malaria parasite prevalence and severe disease outcomes in children.
Highlights
The rates of three common severe malaria phenotypes–severe malaria anaemia (SMA), respiratory distress (RD) and cerebral malaria
For a given time-site, the number of malaria admissions for each severe phenotype was modelled with three model forms: intercept-only, log-linear, and three-parameter log-logistic models. These model forms were compared using the difference in model deviance information criterion (ΔDIC) [19] to test the hypothesis that severe malaria rates were independent of a linear or asymptotic function of community parasite prevalence
The selected model suggests that with every 25% increase in community parasite prevalence, annual severe malaria admission rates approximately doubled (2.06 HDI: 1.58 to 2.73)
Summary
The rates of three common severe malaria phenotypes–severe malaria anaemia (SMA), respiratory distress (RD) and cerebral malaria Understanding how changes in community parasite prevalence alters the rate and age distribution of children hospitalized with severe malaria is essential for optimizing and predicting the impact of malaria control efforts. To define the incidence of pediatric severe malaria admissions against community-based levels of parasite prevalence (age-standardised Plasmodium falciparum parasite rate, PfPR2-10), we analysed active surveillance data from 13 hospitals in East Africa.
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