Kepha Stella, Nikolay Birgit, Nuwaha Fred, Mwandawiro Charles S, Nankabirwa Joaniter, Ndibazza Juliet, Cano Jorge, Matoke-Muhia Damaris, Pullan Rachel L, Allen Elizabeth, Halliday Katherine E, Brooker Simon J
School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
London School of Hygiene and Tropical Medicine, London, UK.
Malar J. 2016 Mar 11;15:157. doi: 10.1186/s12936-016-1176-y.
Malaria among school children is increasingly receiving attention, yet the burden of malaria in this age group is poorly defined. This study presents data on malaria morbidity among school children in Bungoma county, western Kenya.
This study investigated the burden and risk factors of Plasmodium falciparum infection, clinical malaria, and anaemia among 2346 school children aged 5-15 years, who were enrolled in an individually randomized trial evaluating the effect of anthelmintic treatment on the risks of malaria. At baseline, children were assessed for anaemia and nutritional status and information on household characteristics was collected. Children were followed-up for 13 months to assess the incidence of clinical malaria by active detection, and P. falciparum infection and density evaluated using repeated cross-sectional surveys over 15 months.
On average prevalence of P. falciparum infection was 42% and ranged between 32 and 48% during the five cross-sectional surveys. Plasmodium falciparum prevalence was significantly higher among boys than girls. The overall incidence of clinical malaria was 0.26 episodes per person year (95% confidence interval, 0.24-0.29) and was significantly higher among girls (0.23 versus 0.31, episodes per person years). Both infection prevalence and clinical disease varied by season. In multivariable analysis, P. falciparum infection was associated with being male, lower socioeconomic status and stunting. The risk of clinical malaria was associated with being female.
These findings show that the burden of P. falciparum parasitaemia, clinical malaria and anaemia among school children is not insignificant, and suggest that malaria control programmes should be expanded to include this age group.
在校儿童中的疟疾问题日益受到关注，但该年龄组的疟疾负担仍界定不清。本研究呈现了肯尼亚西部邦戈马县在校儿童疟疾发病情况的数据。
本研究调查了2346名5至15岁在校儿童中恶性疟原虫感染、临床疟疾和贫血的负担及危险因素，这些儿童参与了一项评估驱虫治疗对疟疾风险影响的个体随机试验。在基线时，评估儿童的贫血和营养状况，并收集家庭特征信息。对儿童进行13个月的随访，通过主动检测评估临床疟疾的发病率，并在15个月内通过重复横断面调查评估恶性疟原虫感染及密度。
在五次横断面调查中，恶性疟原虫感染的平均患病率为42%，范围在32%至48%之间。男孩中的恶性疟原虫患病率显著高于女孩。临床疟疾的总体发病率为每人每年0.26例（95%置信区间，0.24 - 0.29），女孩中的发病率显著更高（每人每年0.23例对0.31例）。感染患病率和临床疾病均随季节变化。在多变量分析中，恶性疟原虫感染与男性、社会经济地位较低和发育迟缓有关。临床疟疾的风险与女性有关。
这些发现表明，在校儿童中恶性疟原虫血症、临床疟疾和贫血的负担不容忽视，并建议扩大疟疾控制项目以纳入该年龄组。
