Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA.
Am J Trop Med Hyg. 2010 Mar;82(3):391-7. doi: 10.4269/ajtmh.2010.09-0047.
The epidemiology of malaria in urban environments is poorly characterized, yet increasingly problematic. We conducted an unmatched case-control study of risk factors for malarial anemia with high parasitemia in urban Kisumu, Kenya, from June 2002 through February 2003. Cases (n = 80) were hospital patients with a hemoglobin level < or = 8 g/dL and a Plasmodium parasite density > or = 10,000/microL. Controls (n = 826) were healthy respondents to a concurrent citywide knowledge, attitude, and practice survey. Children who reported spending at least one night per month in a rural area were especially at risk (35% of cases; odds ratio = 9.3, 95% confidence interval [CI] = 4.4-19.7, P < 0.0001), and use of mosquito coils, bed net ownership, and house construction were non-significant, potentially indicating that malaria exposure during rural travel comprises an important element of risk. Control of severe malaria in an urban setting may be complicated by Plasmodium infections acquired elsewhere. Epidemiologic studies of urban malaria in low transmission settings should take travel history into account.
城市环境中的疟疾流行病学特征描述不足，但问题日益严重。我们在肯尼亚基苏木市进行了一项针对高寄生虫密度疟疾病例的未匹配病例对照研究，时间为 2002 年 6 月至 2003 年 2 月。病例（n=80）为血红蛋白水平<或=8g/dL 且疟原虫密度>或=10000/microL 的住院患者。对照（n=826）为同期全市知识、态度和实践调查的健康应答者。报告每月至少在农村地区过夜一晚的儿童风险特别高（35%的病例；比值比=9.3，95%置信区间[CI]=4.4-19.7，P<0.0001），而使用蚊香、蚊帐拥有率和房屋结构无显著意义，这可能表明在农村旅行期间接触疟疾是一个重要的风险因素。在城市环境中控制严重疟疾可能会因在其他地方感染疟原虫而变得复杂。在低传播环境中进行城市疟疾的流行病学研究应考虑旅行史。
