Age and geographic patterns of Plasmodium falciparum malaria infection in a representative sample of children living in Burkitt lymphoma-endemic areas of northern Uganda.
Falciparum malaria is an important risk factor for African Burkitt lymphoma (BL), but few studies have evaluated malaria patterns in healthy BL-age children in populations where both diseases are endemic. To obtain accurate current data, patterns of asymptomatic malaria were investigated in northern Uganda, where BL is endemic.



Between 2011 and 2015, 1150 apparently healthy children under 15 years old were sampled from 100 villages in northern Uganda using a stratified, multi-stage, cluster survey design. Falciparum malaria prevalence (pfPR) was assessed by questionnaire, rapid diagnostic test (RDT) and thick film microscopy (TFM). Weighted pfPR and unadjusted and adjusted associations of prevalence with covariates were calculated using logistic models and survey methods.



Based on 1143 children successfully tested, weighted pfPR was 54.8% by RDT and 43.4% by TFM. RDT sensitivity and specificity were 97.5 and 77.8%, respectively, as compared to TFM, because RDT detect malaria antigens, which persist in peripheral blood after clinical malaria, thus results based on RDT are reported. Weighted pfPR increased from 40% in children aged under 2 years to 61.8% in children aged 6-8 years (odds ratio 2.42, 95% confidence interval (CI) 1.26-4.65), then fell slightly to 49% in those aged 12-15 years. Geometric mean parasite density was 1805.5 parasites/µL (95% CI 1344.6-2424.3) among TFM-positive participants, and it was higher in children aged <5 years at 5092.9/µL (95% CI 2892.7-8966.8) and lower in those aged ≥10 years at 983.8/µL (95% CI 472.7-2047.4; P = 0.001). Weighted pfPR was lower in children residing in sub-regions employing indoor residual spraying (IRS) than in those residing in non-IRS sub-regions (32.8 versus 65.7%; OR 0.26, 95% CI 0.14, 0.46). However, pfPR varied both within IRS (3.2-55.3%) and non-IRS sub-regions (29.8-75.8%; Pheterogeneity <0.001). pfPR was inversely correlated with a child's mother's income (P = 0.011) and positively correlated with being enrolled in the wet season (P = 0.076), but sex was irrelevant.



The study observed high but geographically and demographically heterogenous patterns of asymptomatic malaria prevalence among children living in northern Uganda. These results provide important baseline data that will enable precise evaluation of associations between malaria and BL.
Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
Marlena
M
Maziarz
EMBLEM Study, African Field Epidemiology Network, Kampala, Uganda.|St. Mary's Hospital, Lacor, Gulu, Uganda.
Tobias
T
Kinyera
EMBLEM Study, African Field Epidemiology Network, Kampala, Uganda.|St. Mary's Hospital, Lacor, Gulu, Uganda.
Isaac
I
Otim
EMBLEM Study, African Field Epidemiology Network, Kampala, Uganda.|St. Mary's Hospital, Lacor, Gulu, Uganda.
Paul
P
Kagwa
EMBLEM Study, African Field Epidemiology Network, Kampala, Uganda.|St. Mary's Hospital, Lacor, Gulu, Uganda.
Hadijah
H
Nabalende
EMBLEM Study, African Field Epidemiology Network, Kampala, Uganda.|St. Mary's Hospital, Lacor, Gulu, Uganda.
Ismail D
ID
Legason
EMBLEM Study, African Field Epidemiology Network, Kampala, Uganda.|St. Mary's Hospital, Lacor, Gulu, Uganda.
Martin D
MD
Ogwang
Department of Medical Microbiology, Makerere Medical School, Kampala, Uganda.
Samuel
S
Kirimunda
Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.|University of Maryland, Baltimore, MD, USA.
Benjamin
B
Emmanuel
Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA.
Steven J
SJ
Reynolds
EMBLEM Study, African Field Epidemiology Network, Kampala, Uganda.|Kuluva Hospital, Kuluva, Arua, Uganda.
Patrick
P
Kerchan
Department of Medical Microbiology, Makerere Medical School, Kampala, Uganda.
Moses M
MM
Joloba
Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
Andrew W
AW
Bergen
Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
Kishor
K
Bhatia
World Health Organization, Regional Office for Africa, Brazzaville, Congo.
Ambrose O
AO
Talisuna
Institute of Health and Biotechnical Innovation, Queensland University of Technology, Brisbane, Australia.
Robert J
RJ
Biggar
Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
James J
JJ
Goedert
Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA. pfeiffer@mail.nih.gov.
Ruth M
RM
Pfeiffer
Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA. mbulaits@mail.nih.gov.
Sam M
SM
Mbulaiteye
D000293:Adolescent; D002051:Burkitt Lymphoma / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D003955:Diagnostic Tests, Routine; D019353:Endemic Diseases; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016778:Malaria, Falciparum / Q000453:epidemiology* / Q000469:parasitology; D008297:Male; D010963:Plasmodium falciparum / Q000302:isolation & purification; D015995:Prevalence; D012680:Sensitivity and Specificity; D014454:Uganda / Q000453:epidemiology
Africa; Burkitt lymphoma; Epidemiology; Malaria; Non-Hodgkin lymphoma; Plasmodium falciparum; Uganda