Decreasing incidence of severe malaria and community-acquired bacteraemia among hospitalized children in Muheza, north-eastern Tanzania, 2006-2010.
BACKGROUND
The annual incidence and temporal trend of severe malaria and community-acquired bacteraemia during a four-year period in Muheza, Tanzania was assessed.


METHODS
Data on severely ill febrile children aged 2 months to 14 years from three prospective studies conducted at Muheza District Hospital from 2006 to 2010 was pooled and analysed. On admission, each enrolled child had a thin and thick blood film and at least one rapid diagnostic test for falciparum malaria, as well as a blood culture. The annual incidence of bacteraemia and severe malaria among children coming from Muheza was calculated and their temporal trend was assessed.


RESULTS
Overall, 1, 898 severe falciparum malaria and 684 bacteraemia cases were included. Of these, 1, 356 (71%) and 482 (71%), respectively, were from the referral population of Muheza. The incidence of falciparum malaria and all-cause bacteraemia in Muheza decreased five-fold and three-fold, respectively, from the first to the fourth year of surveillance (p < 0.0001). During this period, the median ages of children from Muheza admitted with severe malaria increased from 1.7 to 2.5 years (p < 0.0001). The reduction in all-cause bacteraemia was mainly driven by the 11-fold decline in the incidence of non-typhoidal salmonellosis. The annual incidences of Haemophilus influenzae and pneumococcal invasive bacterial infections decreased as well but were much fewer in number.


CONCLUSIONS
These results add to the growing evidence of the decline in malaria associated with a decrease in non-typhoidal salmonellosis and possibly other bacteraemias. Malarial prevention and control strategies may provide a greater benefit than the mere reduction of malaria alone.
National Institute for Medical Research - Amani Centre, Tanga, Tanzania.
George
G
Mtove
Ben
B
Amos
Behzad
B
Nadjm
Ilse C E
IC
Hendriksen
Arjen M
AM
Dondorp
Abraham
A
Mwambuli
Deok Ryun
DR
Kim
R Leon
RL
Ochiai
John D
JD
Clemens
Lorenz
L
von Seidlein
Hugh
H
Reyburn
Jacqueline
J
Deen
D000293:Adolescent; D016470:Bacteremia / Q000453:epidemiology*; D002648:Child; D002673:Child, Hospitalized; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000453:epidemiology*; D005260:Female; D006192:Haemophilus Infections / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D008288:Malaria / Q000453:epidemiology*; D008297:Male; D011008:Pneumococcal Infections / Q000453:epidemiology; D011446:Prospective Studies; D012480:Salmonella Infections / Q000453:epidemiology; D013636:Tanzania / Q000453:epidemiology; D014435:Typhoid Fever / Q000453:epidemiology