title: Malaria Parasitemia Among Febrile Patients Seeking Clinical Care at an Outpatient Health Facility in an Urban Informal Settlement Area in Nairobi, Kenya.
abstract: Nairobi is considered a low-risk area for malaria transmission, but travel can influence transmission of malaria. We investigated the demographic characteristics and travel history of patients with documented fever and malaria in a study clinic in a population-based surveillance system over a 5-year period, January 1, 2007 to December 31, 2011. During the study period, 11,480 (68%) febrile patients had a microscopy test performed for malaria, of which 2,553 (22%) were positive. Malaria was detected year-round with peaks in January, May, and September. Children aged 5-14 years had the highest proportion (28%) of positive results followed by children aged 1-4 years (23%). Almost two-thirds of patients with malaria reported traveling outside Nairobi; 79% of these traveled to three counties in western Kenya. History of recent travel (i.e., in past month) was associated with malaria parasitemia (odds ratio: 10.0, 95% confidence interval: 9.0-11.0). Malaria parasitemia was frequently observed among febrile patients at a health facility in the urban slum of Kibera, Nairobi. The majority of patients had traveled to western Kenya. However, 34% reported no travel history, which raises the possibility of local malaria transmission in this densely populated, urban setting. These findings have important implications for malaria control in large Nairobi settlements.
authors.forename: Henry N
authors.initials: HN
authors.lastname: Njuguna
authors.forename: Joel M
authors.initials: JM
authors.lastname: Montgomery
authors.forename: Leonard
authors.initials: L
authors.lastname: Cosmas
authors.forename: Newton
authors.initials: N
authors.lastname: Wamola
authors.forename: Joseph O
authors.initials: JO
authors.lastname: Oundo
authors.forename: Meghna
authors.initials: M
authors.lastname: Desai
authors.forename: Ann M
authors.initials: AM
authors.lastname: Buff
authors.forename: Robert F
authors.initials: RF
authors.lastname: Breiman
mesh_terms: D000293:Adolescent; D000554:Ambulatory Care Facilities; D002648:Child; D002675:Child, Preschool; D005260:Female; D005334:Fever / Q000209:etiology*; D006801:Humans; D007223:Infant; D007630:Kenya / Q000453:epidemiology; D008288:Malaria / Q000097:blood* / Q000453:epidemiology / Q000469:parasitology; D008297:Male; D018512:Parasitemia / Q000453:epidemiology*; D014505:Urban Population