Factors determining the heterogeneity of malaria incidence in children in Kampala, Uganda.
BACKGROUND
Malaria risk may be heterogeneous in urban areas of Africa. Identifying those at highest risk for malaria may lead to more targeted approaches to malaria control.


METHODS
A representative sample of 558 children aged 1-10 years were recruited from a census population in a single parish of Kampala and followed up for 2 years. Malaria was diagnosed when a child presented with a new episode of fever and a thick blood smear positive for parasites. Multivariate analysis was used to identify independent predictors of malaria incidence.


RESULTS
A total of 695 episodes of uncomplicated malaria were diagnosed after 901 person years of follow-up. Sickle cell trait (relative risk [RR], 0.68 [95% confidence interval {CI}, 0.52-0.90]), glucose-6-phosphate dehydrogenase deficiency in female children (RR, 0.48 [95% CI, 0.31-0.75]), and use of an insecticide-treated bed net (RR, 0.52 [95% CI, 0.32-0.83]) were associated with a lower risk of malaria. The distance of the subject's residence from a swamp bordering the parish showed a strong "dose-response" relationship; living in the swamp was the strongest predictor of malaria risk (RR, 3.94 [95% CI, 2.61-5.97]).


CONCLUSIONS
Malaria incidence was highly heterogeneous in this urban cohort of children. Malaria control interventions in urban areas should target populations living in pockets of high malaria risk.
Department of Medicine, University of California, San Francisco, CA 94143, USA.
Tamara D
TD
Clark
Bryan
B
Greenhouse
Denise
D
Njama-Meya
Bridget
B
Nzarubara
Catherine
C
Maiteki-Sebuguzi
Sarah G
SG
Staedke
Edmund
E
Seto
Moses R
MR
Kamya
Philip J
PJ
Rosenthal
Grant
G
Dorsey
D000755:Anemia, Sickle Cell; D000818:Animals; D001769:Blood / Q000469:parasitology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005843:Geography; D005954:Glucosephosphate Dehydrogenase / Q000235:genetics; D006801:Humans; D015994:Incidence; D007223:Infant; D008137:Longitudinal Studies; D008288:Malaria / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D015999:Multivariate Analysis; D010961:Plasmodium / Q000302:isolation & purification; D011482:Protective Devices; D012307:Risk Factors; D014454:Uganda / Q000453:epidemiology
D005954:Glucosephosphate Dehydrogenase