title: A decline in the incidence of invasive non-typhoidal Salmonella infection in The Gambia temporally associated with a decline in malaria infection.
abstract: BACKGROUND
  Malaria is a risk factor for invasive non-typhoidal Salmonella (NTS) infection in children. In the last 10 years, indices of malaria infection in The Gambia have fallen substantially.
  
  
  METHODS
  We compared temporal trends of childhood malaria and NTS infection in two Gambian locations. In Fajara, on the coast, the incidence of NTS infection at three time points between 1979 and 2005 was compared to the percentage of malaria positive outpatient thick blood films and the percentage of admissions associated with malaria over time. In Basse, in the eastern part of the country, the incidence of NTS infection at three time points between 1989 and 2008 was compared to the prevalence of malaria parasitaemia at four time points between 1992 and 2008.
  
  
  RESULTS
  The estimated incidence of NTS infection in Fajara fell from 60 (1979-1984) to 10 (2003-05) cases per 100,000 person years. The proportion of outpatients in Fajara with suspected malaria who were parasitaemic fell from 33% (1999) to 6% (2007) while the proportion of admissions associated with malaria fell from 14.5% (1999) to 5% (2007). In Basse, the estimated incidence of NTS infection fell from 105 (1989-1991) to 29 (2008) cases per 100,000 person years while the prevalence of malaria parasitaemia fell from 45% (1992) to 10% (2008). The incidence of pneumococcal bacteraemia in Fajara and Basse did not fall over the study period.
  
  
  CONCLUSIONS
  These data support an association between malaria and NTS infection. Reductions in malaria infection may be associated with reduced rates of invasive childhood NTS infection.
authors.affiliation: Medical Research Council (United Kingdom) The Gambia, Fajara, The Gambia. gmackenzie@mrc.gm
authors.forename: Grant
authors.initials: G
authors.lastname: Mackenzie
authors.forename: Serign J
authors.initials: SJ
authors.lastname: Ceesay
authors.forename: Philip C
authors.initials: PC
authors.lastname: Hill
authors.forename: Michael
authors.initials: M
authors.lastname: Walther
authors.forename: Kalifa A
authors.initials: KA
authors.lastname: Bojang
authors.forename: Judith
authors.initials: J
authors.lastname: Satoguina
authors.forename: Godwin
authors.initials: G
authors.lastname: Enwere
authors.forename: Umberto
authors.initials: U
authors.lastname: D'Alessandro
authors.forename: Debasish
authors.initials: D
authors.lastname: Saha
authors.forename: Usman N A
authors.initials: UN
authors.lastname: Ikumapayi
authors.forename: Tim
authors.initials: T
authors.lastname: O'Dempsey
authors.forename: David C W
authors.initials: DC
authors.lastname: Mabey
authors.forename: Tumani
authors.initials: T
authors.lastname: Corrah
authors.forename: David J
authors.initials: DJ
authors.lastname: Conway
authors.forename: Richard A
authors.initials: RA
authors.lastname: Adegbola
authors.forename: Brian M
authors.initials: BM
authors.lastname: Greenwood
mesh_terms: D016470:Bacteremia / Q000150:complications / Q000453:epidemiology; D002648:Child; D005714:Gambia / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008288:Malaria / Q000150:complications* / Q000453:epidemiology*; D011008:Pneumococcal Infections / Q000150:complications / Q000453:epidemiology / Q000382:microbiology; D012480:Salmonella Infections / Q000150:complications* / Q000453:epidemiology* / Q000382:microbiology; D013997:Time Factors; D014435:Typhoid Fever / Q000150:complications / Q000453:epidemiology / Q000382:microbiology