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Age, Spatial, and Temporal Variations in Hospital Admissions with Malaria in Kilifi County, Kenya: A 25-Year Longitudinal Observational Study

Authors :
Mogeni, Polycarp
Williams, Thomas N.
Fegan, Gregory
Nyundo, Christopher
Bauni, Evasius
Mwai, Kennedy
Omedo, Irene
Njuguna, Patricia
Newton, Charles R.
Osier, Faith
Berkley, James A.
Hammitt, Laura L.
Lowe, Brett
Mwambingu, Gabriel
Awuondo, Ken
Mturi, Neema
Peshu, Norbert
Snow, Robert W.
Noor, Abdisalan
Marsh, Kevin
Bejon, Philip
Source :
PLoS Medicine. June 28, 2016, Vol. 13 Issue 6, e1002047
Publication Year :
2016

Abstract

Background Encouraging progress has been seen with reductions in Plasmodium falciparum malaria transmission in some parts of Africa. Reduced transmission might lead to increasing susceptibility to malaria among older children due to lower acquired immunity, and this has implications for ongoing control strategies. Methods and Findings We conducted a longitudinal observational study of children admitted to Kilifi County Hospital in Kenya and linked it to data on residence and insecticide-treated net (ITN) use. This included data from 69,104 children aged from 3 mo to 13 y admitted to Kilifi County Hospital between 1 January 1990 and 31 December 2014. The variation in malaria slide positivity among admissions was examined in logistic regression models using the following predictors: location of the residence, calendar time, the child's age, ITN use, and the enhanced vegetation index (a proxy for soil moisture). The proportion of malaria slide-positive admissions declined from 0.56 (95% confidence interval [CI] 0.54-0.58) in 1998 to 0.07 (95% CI 0.06-0.08) in 2009 but then increased again through to 0.24 (95% CI 0.22-0.25) in 2014. Older children accounted for most of the increase after 2009 (0.035 [95% CI 0.030-0.040] among young children compared to 0.22 [95% CI 0.21-0.23] in older children). There was a nonlinear relationship between malaria risk and prevalence of ITN use within a 2 km radius of an admitted child's residence such that the predicted malaria positive fraction varied from ~0.4 to Conclusion Following a period of reduced transmission, a cohort of older children emerged who have increased susceptibility to malaria. Further reductions in malaria transmission are needed to mitigate the increasing burden among older children, and universal ITN coverage is a promising strategy to achieve this goal.<br />Author(s): Polycarp Mogeni 1,*, Thomas N. Williams 1,2, Gregory Fegan 1,3, Christopher Nyundo 1, Evasius Bauni 1, Kennedy Mwai 1, Irene Omedo 1, Patricia Njuguna 1, Charles R. Newton 1,3, [...]

Details

Language :
English
ISSN :
15491277
Volume :
13
Issue :
6
Database :
Gale General OneFile
Journal :
PLoS Medicine
Publication Type :
Academic Journal
Accession number :
edsgcl.479522955
Full Text :
https://doi.org/10.1371/journal.pmed.1002047