Shanks G Dennis, Biomndo Kimutai, Maguire Jason
US Army Medical Research Unit--Kenya.
J Travel Med. 2004 Nov-Dec;11(6):354-7. doi: 10.2310/7060.2004.19203.
Over the past two decades, endemic malaria returned to the western highlands of Kenya, a region that had been free of endemic malaria during the preceding 30 years. A study of malaria patients admitted to a tea estate hospital was conducted to estimate the risk of severe malaria when acquired during travel away from the tea estates compared with infections that had probably been locally acquired.
From May 1998 to March 2000, 1,296 patients were evaluated with a case-control design and standardized questionnaire during their hospitalization. Death certificates from the tea estates were examined from 1964 to 1972 and 1986 to 1999.
Travel away from the tea estates during the 2 months prior to hospitalization (n = 432) was strongly associated with a diagnosis of malaria (odds ratio 2.7, 95% CI 2.1-3.5). The estimate of risk associated with travel was consistent with known malaria endemicity, the Rift Valley Province having a much lower malaria transmission than the area around Lake Victoria. The seasonality of malaria-related deaths indicates that many lowland-origin children probably contracted their fatal infection away from the tea plantation.
Travel within Kenya is a significant risk factor for hospitalization owing to malaria on the tea estates; expatriate travelers need to be aware that the East African highlands cannot be regarded as malaria free.
在过去二十年中，肯尼亚西部高地再度出现地方性疟疾，该地区在之前三十年一直没有地方性疟疾。对一家茶园医院收治的疟疾患者进行了一项研究，以评估在离开茶园旅行期间感染疟疾与可能在当地感染相比发生重症疟疾的风险。
1998年5月至2000年3月期间，1296例患者在住院期间采用病例对照设计和标准化问卷进行评估。查阅了1964年至1972年以及1986年至1999年茶园的死亡证明。
住院前2个月内离开茶园（n = 432）与疟疾诊断密切相关（比值比2.7，95%可信区间2.1 - 3.5）。与旅行相关的风险估计与已知的疟疾流行情况一致，裂谷省的疟疾传播率远低于维多利亚湖周边地区。与疟疾相关的死亡季节性表明，许多来自低地的儿童可能是在远离茶园的地方感染了致命疟疾。
在肯尼亚境内旅行是茶园因疟疾住院的一个重要风险因素；外籍旅行者需要意识到东非高地不能被视为无疟疾地区。
