Risk of malaria attacks in Gambian children is greater away from malaria vector breeding sites

The causes of local variation in the prevalence of malaria were investigated in rural Gambia. Cross-sectional prevalence surveys were carried out among 1184 young children (aged 6 months–5 years) in 48 villages, at the end of the transmission season in 1996. Villages were categorized according to di...

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Bibliographic Details
Published in:Transactions of the Royal Society of Tropical Medicine and Hygiene 2002-09, Vol.96 (5), p.499-506
Main Authors: Clarke, Siân E., Bøgh, Claus, Brown, Richard C., Walraven, Gijs E.L., Thomas, Chris J., Lindsay, Steve W.
Format: Article
Language:English
Subjects:
Animals
Biological and medical sciences
Child, Preschool
children
clinical attack prevalence
Cross-Sectional Studies
entomological inoculation rate
Female
Gambia - epidemiology
Human protozoal diseases
Humans
Infant
Infectious diseases
Insect Vectors - parasitology
Malaria
Malaria, Falciparum - epidemiology
Malaria, Falciparum - transmission
Male
Medical sciences
Parasitic diseases
Plasmodium falciparum
Prevalence
Protozoal diseases
Residence Characteristics
Risk Factors
The Gambia
Tropical medicine
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Summary:The causes of local variation in the prevalence of malaria were investigated in rural Gambia. Cross-sectional prevalence surveys were carried out among 1184 young children (aged 6 months–5 years) in 48 villages, at the end of the transmission season in 1996. Villages were categorized according to distance from the nearest vector breeding sites, and the patterns of malaria transmission, infection and disease compared. Children living in villages within 3 km of breeding sites experienced more infective bites, and higher prevalences of parasitaemia and spleen enlargement than less-exposed children living further away. Clinical illness, in contrast, was more common among infected children who were less exposed. Infected children living 3 km or more from breeding sites were more likely to have high-density parasitaemia (odds ratio [OR] = 1 · 98), fever (OR = 2 · 60) and high-density parasitaemia together with fever (OR = 3 · 17). Clinical attacks did not decline in older children, as seen amongst children who were more exposed. These findings show that significant differences in the risk of infection and clinical attacks can occur over very short distances. The age at which protective immunity is acquired may be delayed in villages where transmission intensity is lower, thus increasing the risk of a clinical attack following infection. Communities with the lowest vector densities may be those at greatest risk of disease.
ISSN:0035-9203
1878-3503
DOI:10.1016/S0035-9203(02)90419-0