Kamau Alice, Obiet Kizito, Ogwang Caroline, McDermott Daniel P, Lesosky Maia, Janssen Julia, Odongo Wycliffe, Gutman Julie R, Schultz Jonathan S, Nicholas Wycliffe, Seda Brian, Chepkirui Mercy, Aduwo Frank, Towett Oliver, Otieno Kephas, Donnelly Martin J, Ochomo Eric, Kariuki Simon, Samuels Aaron M, O Ter Kuile Feiko, Staedke Sarah G
Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
KEMRI Centre for Global Health Research, Kisumu, Kenya.
Malar J. 2024 Dec 30;23(1):403. doi: 10.1186/s12936-024-05234-0.
In western Kenya, a cluster-randomized trial is assessing the impact of attractive targeted sugar baits (ATSBs) on malaria in children enrolled in three consecutive cohorts. Here, characteristics of children and households at enrolment, and factors associated with baseline malaria prevalence are described.
Children aged 1 to < 15 years were randomly selected by cluster (n = 70) from a census database. Cohorts were enrolled in March-April 2022, September-October 2022, and March-April 2023. ATSBs were deployed in March 2022. At enrolment, all participants were tested for malaria by rapid diagnostic test (RDT). After enrolment a household survey was conducted. Household structures were classified as 'improved' (finished walls and roofs, and closed eaves) or 'traditional' (all other construction). A generalized linear mixed model was used to assess factors associated with malaria prevalence.
Of 3705 children screened, 220 declined and 523 were excluded, due to plans to leave the study area (n = 392), ineligible age (n = 64) or other reason (n = 67). Overall, 2962 children were enrolled. Bed net use the previous night was more common in children aged 1-4 years (746/777 [96%]) than those aged 5-<15 years (1806/2157 [84%], p < 0.001). Of the 2644 households surveyed (for 2,886 participants), information on house construction was available for 2595. Of these, only 199 (8%) were categorized as 'improved', as most houses had open eaves. While 99% of households owned at least one bed net, only 51% were adequately covered (one net per two household residents). Among 999 children enrolled in the first cohort (baseline), 498 (50%) tested positive by RDT. In an adjusted multivariable analysis, factors associated with RDT positivity included sub-county (Alego-Usonga vs Rarieda, adjusted odds ratio [aOR] 4.81; 95% CI: 2.74-8.45; p < 0.001), house construction (traditional vs improved, aOR 2.80; 95% CI: 1.59-4.95; p < 0.001), and age (5-< 15 vs 1-4 years, aOR 1.64; 95% CI: 1.13-2.37; p = 0.009).
In western Kenya, the burden of malaria in children remains high. Most households owned a bed net, but coverage was inadequate. Residents of Alego-Usonga sub-county, those living in traditionally constructed households, and older children were more likely to test positive by RDT. Additional tools are needed to effectively control malaria in this area. Trial registration The ATSB trial is registered under Clinicaltrials.gov NCT05219565.
在肯尼亚西部，一项整群随机试验正在评估有吸引力的靶向糖饵（ATSBs）对连续三个队列中儿童疟疾的影响。在此，描述了入组时儿童和家庭的特征，以及与基线疟疾患病率相关的因素。
从人口普查数据库中按整群随机抽取1至<15岁的儿童（n = 70）。队列分别于2022年3月至4月、2022年9月至10月和2023年3月至4月入组。ATSBs于2022年3月部署。入组时，所有参与者均通过快速诊断试验（RDT）检测疟疾。入组后进行了家庭调查。家庭结构分为“改良型”（墙壁和屋顶完工，屋檐封闭）或“传统型”（所有其他建筑类型）。使用广义线性混合模型评估与疟疾患病率相关的因素。
在筛查的3705名儿童中，220名拒绝参与，523名被排除，原因包括计划离开研究区域（n = 392）、年龄不符合要求（n = 64）或其他原因（n = 67）。总体而言，2962名儿童入组。前一晚使用蚊帐在1至4岁儿童中更为常见（746/777 [96%]），高于5至<15岁儿童（1806/2157 [84%]，p < 0.001）。在接受调查的2644户家庭（涉及2886名参与者）中，有2595户提供了房屋建筑信息。其中，只有199户（8%）被归类为“改良型”，因为大多数房屋的屋檐是开放的。虽然99%的家庭拥有至少一顶蚊帐，但只有51%的家庭覆盖率足够（每两名家庭居民一顶蚊帐）。在第一个队列（基线）入组的999名儿童中，498名（50%）RDT检测呈阳性。在调整后的多变量分析中，与RDT阳性相关的因素包括次县（阿莱戈 - 乌松加与拉里达，调整后的优势比[aOR] 4.81；95%置信区间：2.74 - 8.45；p < < 0.001）、房屋建筑类型（传统型与改良型，aOR 2.80；95%置信区间：1.59 - 4.95；p < 0.001）和年龄（5至<15岁与1至4岁，aOR 1.64；95%置信区间：1.13 - 2.37；p = 0.009）。
在肯尼亚西部，儿童疟疾负担仍然很高。大多数家庭拥有蚊帐，但覆盖率不足。阿莱戈 - 乌松加次县的居民、居住在传统建筑家庭的居民以及年龄较大的儿童RDT检测呈阳性的可能性更大。需要额外的工具来有效控制该地区的疟疾。试验注册：ATSB试验已在Clinicaltrials.gov上注册，注册号为NCT05219565。
