title: Malaria epidemics and interventions, Kenya, Burundi, southern Sudan, and Ethiopia, 1999-2004.
abstract: Quantitative data on the onset and evolution of malaria epidemics are scarce. We review case studies from recent African Plasmodium falciparum epidemics (Kisii and Gucha Districts, Kenya, 1999; Kayanza Province, Burundi, 2000-2001; Aweil East, southern Sudan, 2003; Gutten and Damot Gale, Ethiopia, 2003-2004). We highlight possible epidemic risk factors and review delays in epidemic detection and response (up to 20 weeks), essentially due to poor case reporting and analysis or low use of public facilities. Epidemics lasted 15-36 weeks, and patients' age profiles suggested departures from classical notions of epidemic malaria everywhere but Burundi. Although emergency interventions were mounted to expand inpatient and outpatient treatment access, we believe their effects were lessened because of delays, insufficient evaluation of disease burden, lack of evidence on how to increase treatment coverage in emergencies, and use of ineffective drugs.
authors.affiliation: Department of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, United Kingdom. francesco.checchi@lshtm.ac.uk
authors.forename: Francesco
authors.initials: F
authors.lastname: Checchi
authors.forename: Jonathan
authors.initials: J
authors.lastname: Cox
authors.forename: Suna
authors.initials: S
authors.lastname: Balkan
authors.forename: Abiy
authors.initials: A
authors.lastname: Tamrat
authors.forename: Gerardo
authors.initials: G
authors.lastname: Priotto
authors.forename: Kathryn P
authors.initials: KP
authors.lastname: Alberti
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Guthmann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D002063:Burundi / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D007630:Kenya / Q000453:epidemiology; D016778:Malaria, Falciparum / Q000453:epidemiology* / Q000401:mortality / Q000469:parasitology; D008297:Male; D008875:Middle Aged; D010963:Plasmodium falciparum / Q000302:isolation & purification*; D013397:Sudan / Q000453:epidemiology