title: Severe Flooding and Malaria Transmission in the Western Ugandan Highlands: Implications for Disease Control in an Era of Global Climate Change.
abstract: BACKGROUND
  There are several mechanisms by which global climate change may impact malaria transmission. We sought to assess how the increased frequency of extreme precipitation events associated with global climate change will influence malaria transmission in highland areas of East Africa.
  
  
  METHODS
  We used a differences-in-differences, quasi-experimental design to examine spatial variability in the incidence rate of laboratory-confirmed malaria cases and malaria-related hospitalizations between villages (1) at high versus low elevations, (2) with versus without rivers, and (3) upstream versus downstream before and after severe flooding that occurred in Kasese District, Western Region, Uganda, in May 2013.
  
  
  RESULTS
  During the study period, 7596 diagnostic tests were performed, and 1285 patients were admitted with a diagnosis of malaria. We observed that extreme flooding resulted in an increase of approximately 30% in the risk of an individual having a positive result of a malaria diagnostic test in the postflood period in villages bordering a flood-affected river, compared with villages farther from a river, with a larger relative impact on upstream versus downstream villages (adjusted rate ratio, 1.91 vs 1.33).
  
  
  CONCLUSIONS
  Extreme precipitation such as the flooding described here may pose significant challenges to malaria control programs and will demand timely responses to mitigate deleterious impacts on human health.
authors.affiliation: Division of Infectious Diseases.
authors.forename: Ross
authors.initials: R
authors.lastname: Boyce
authors.affiliation: Division of General Medicine and Clinical Epidemiology, University of North Carolina School of Medicine.
authors.forename: Raquel
authors.initials: R
authors.lastname: Reyes
authors.affiliation: Department of Community Health, Mbarara University of Science and Technology, Uganda.
authors.forename: Michael
authors.initials: M
authors.lastname: Matte
authors.affiliation: Department of Community Health, Mbarara University of Science and Technology, Uganda.
authors.forename: Moses
authors.initials: M
authors.lastname: Ntaro
authors.affiliation: Department of Community Health, Mbarara University of Science and Technology, Uganda.
authors.forename: Edgar
authors.initials: E
authors.lastname: Mulogo
authors.affiliation: Division of General Internal Medicine, Massachusetts General Hospital.
authors.forename: Joshua P
authors.initials: JP
authors.lastname: Metlay
authors.affiliation: Department of Geography, University of North Carolina, Chapel Hill.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Band
authors.affiliation: Department of Medicine, Harvard Medical School and Massachusetts General Hospital, Boston.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Siedner
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002980:Climate; D057231:Climate Change; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D008288:Malaria / Q000453:epidemiology* / Q000635:transmission*; D008297:Male; D014454:Uganda / Q000453:epidemiology; D014887:Weather
keywords: Malaria; Uganda; climate change; disasters; epidemiology; flooding