title: Malaria transmission, infection, and disease at three sites with varied transmission intensity in Uganda: implications for malaria control.
abstract: The intensification of control interventions has led to marked reductions in malaria burden in some settings, but not others. To provide a comprehensive description of malaria epidemiology in Uganda, we conducted surveillance studies over 24 months in 100 houses randomly selected from each of three subcounties: Walukuba (peri-urban), Kihihi (rural), and Nagongera (rural). Annual entomological inoculation rate (aEIR) was estimated from monthly Centers for Disease Control and Prevention (CDC) light trap mosquito collections. Children aged 0.5-10 years were provided long-lasting insecticidal nets (LLINs) and followed for measures of parasite prevalence, anemia and malaria incidence. Estimates of aEIR were 2.8, 32.0, and 310 infectious bites per year, and estimates of parasite prevalence 7.4%, 9.3%, and 28.7% for Walukuba, Kihihi, and Nagongera, respectively. Over the 2-year study, malaria incidence per person-years decreased in Walukuba (0.51 versus 0.31, P = 0.001) and increased in Kihihi (0.97 versus 1.93, P < 0.001) and Nagongera (2.33 versus 3.30, P < 0.001). Of 2,582 episodes of malaria, only 8 (0.3%) met criteria for severe disease. The prevalence of anemia was low and not associated with transmission intensity. In our cohorts, where LLINs and prompt effective treatment were provided, the risk of complicated malaria and anemia was extremely low. However, malaria incidence was high and increased over time at the two rural sites, suggesting improved community-wide coverage of LLIN and additional malaria control interventions are needed in Uganda.
authors.affiliation: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda; Department of Geography and Environment, University of Southampton, Southampton, United Kingdom; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; London School of Hygiene and Tropical Medicine, London, United Kingdom; School of Biological and Biomedical Sciences, Durham University, Durham, United Kingdom; Department of Zoology, University of Oxford, United Kingdom; Sanaria Institute for Global Health and Tropical Medicine, Rockville, Maryland mkamya@infocom.co.ug.
authors.forename: Moses R
authors.initials: MR
authors.lastname: Kamya
authors.affiliation: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda; Department of Geography and Environment, University of Southampton, Southampton, United Kingdom; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; London School of Hygiene and Tropical Medicine, London, United Kingdom; School of Biological and Biomedical Sciences, Durham University, Durham, United Kingdom; Department of Zoology, University of Oxford, United Kingdom; Sanaria Institute for Global Health and Tropical Medicine, Rockville, Maryland.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Arinaitwe
authors.affiliation: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda; Department of Geography and Environment, University of Southampton, Southampton, United Kingdom; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; London School of Hygiene and Tropical Medicine, London, United Kingdom; School of Biological and Biomedical Sciences, Durham University, Durham, United Kingdom; Department of Zoology, University of Oxford, United Kingdom; Sanaria Institute for Global Health and Tropical Medicine, Rockville, Maryland.
authors.forename: Humphrey
authors.initials: H
authors.lastname: Wanzira
authors.affiliation: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda; Department of Geography and Environment, University of Southampton, Southampton, United Kingdom; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; London School of Hygiene and Tropical Medicine, London, United Kingdom; School of Biological and Biomedical Sciences, Durham University, Durham, United Kingdom; Department of Zoology, University of Oxford, United Kingdom; Sanaria Institute for Global Health and Tropical Medicine, Rockville, Maryland.
authors.forename: Agaba
authors.initials: A
authors.lastname: Katureebe
authors.affiliation: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda; Department of Geography and Environment, University of Southampton, Southampton, United Kingdom; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; London School of Hygiene and Tropical Medicine, London, United Kingdom; School of Biological and Biomedical Sciences, Durham University, Durham, United Kingdom; Department of Zoology, University of Oxford, United Kingdom; Sanaria Institute for Global Health and Tropical Medicine, Rockville, Maryland.
authors.forename: Chris
authors.initials: C
authors.lastname: Barusya
authors.affiliation: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda; Department of Geography and Environment, University of Southampton, Southampton, United Kingdom; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; London School of Hygiene and Tropical Medicine, London, United Kingdom; School of Biological and Biomedical Sciences, Durham University, Durham, United Kingdom; Department of Zoology, University of Oxford, United Kingdom; Sanaria Institute for Global Health and Tropical Medicine, Rockville, Maryland.
authors.forename: Simon P
authors.initials: SP
authors.lastname: Kigozi
authors.affiliation: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda; Department of Geography and Environment, University of Southampton, Southampton, United Kingdom; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; London School of Hygiene and Tropical Medicine, London, United Kingdom; School of Biological and Biomedical Sciences, Durham University, Durham, United Kingdom; Department of Zoology, University of Oxford, United Kingdom; Sanaria Institute for Global Health and Tropical Medicine, Rockville, Maryland.
authors.forename: Maxwell
authors.initials: M
authors.lastname: Kilama
authors.affiliation: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda; Department of Geography and Environment, University of Southampton, Southampton, United Kingdom; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; London School of Hygiene and Tropical Medicine, London, United Kingdom; School of Biological and Biomedical Sciences, Durham University, Durham, United Kingdom; Department of Zoology, University of Oxford, United Kingdom; Sanaria Institute for Global Health and Tropical Medicine, Rockville, Maryland.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Tatem
authors.affiliation: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda; Department of Geography and Environment, University of Southampton, Southampton, United Kingdom; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; London School of Hygiene and Tropical Medicine, London, United Kingdom; School of Biological and Biomedical Sciences, Durham University, Durham, United Kingdom; Department of Zoology, University of Oxford, United Kingdom; Sanaria Institute for Global Health and Tropical Medicine, Rockville, Maryland.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Rosenthal
authors.affiliation: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda; Department of Geography and Environment, University of Southampton, Southampton, United Kingdom; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; London School of Hygiene and Tropical Medicine, London, United Kingdom; School of Biological and Biomedical Sciences, Durham University, Durham, United Kingdom; Department of Zoology, University of Oxford, United Kingdom; Sanaria Institute for Global Health and Tropical Medicine, Rockville, Maryland.
authors.forename: Chris
authors.initials: C
authors.lastname: Drakeley
authors.affiliation: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda; Department of Geography and Environment, University of Southampton, Southampton, United Kingdom; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; London School of Hygiene and Tropical Medicine, London, United Kingdom; School of Biological and Biomedical Sciences, Durham University, Durham, United Kingdom; Department of Zoology, University of Oxford, United Kingdom; Sanaria Institute for Global Health and Tropical Medicine, Rockville, Maryland.
authors.forename: Steve W
authors.initials: SW
authors.lastname: Lindsay
authors.affiliation: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda; Department of Geography and Environment, University of Southampton, Southampton, United Kingdom; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; London School of Hygiene and Tropical Medicine, London, United Kingdom; School of Biological and Biomedical Sciences, Durham University, Durham, United Kingdom; Department of Zoology, University of Oxford, United Kingdom; Sanaria Institute for Global Health and Tropical Medicine, Rockville, Maryland.
authors.forename: Sarah G
authors.initials: SG
authors.lastname: Staedke
authors.affiliation: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda; Department of Geography and Environment, University of Southampton, Southampton, United Kingdom; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; London School of Hygiene and Tropical Medicine, London, United Kingdom; School of Biological and Biomedical Sciences, Durham University, Durham, United Kingdom; Department of Zoology, University of Oxford, United Kingdom; Sanaria Institute for Global Health and Tropical Medicine, Rockville, Maryland.
authors.forename: David L
authors.initials: DL
authors.lastname: Smith
authors.affiliation: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda; Department of Geography and Environment, University of Southampton, Southampton, United Kingdom; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; London School of Hygiene and Tropical Medicine, London, United Kingdom; School of Biological and Biomedical Sciences, Durham University, Durham, United Kingdom; Department of Zoology, University of Oxford, United Kingdom; Sanaria Institute for Global Health and Tropical Medicine, Rockville, Maryland.
authors.forename: Bryan
authors.initials: B
authors.lastname: Greenhouse
authors.affiliation: Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; Infectious Diseases Research Collaboration, Kampala, Uganda; Department of Geography and Environment, University of Southampton, Southampton, United Kingdom; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; London School of Hygiene and Tropical Medicine, London, United Kingdom; School of Biological and Biomedical Sciences, Durham University, Durham, United Kingdom; Department of Zoology, University of Oxford, United Kingdom; Sanaria Institute for Global Health and Tropical Medicine, Rockville, Maryland.
authors.forename: Grant
authors.initials: G
authors.lastname: Dorsey
mesh_terms: D000740:Anemia / Q000188:drug therapy / Q000453:epidemiology; D000818:Animals; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D009033:Culicidae / Q000469:parasitology*; D005260:Female; D005843:Geography; D006801:Humans; D015994:Incidence; D007223:Infant; D007299:Insect Bites and Stings; D007303:Insect Vectors / Q000469:parasitology*; D057148:Insecticide-Treated Bednets; D008288:Malaria / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission*; D008297:Male; D009032:Mosquito Control; D015995:Prevalence; D011446:Prospective Studies; D012424:Rural Population; D014454:Uganda / Q000453:epidemiology