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Am. J. Trop. Med. Hyg., 69(3), 2003, pp. 244-246
Copyright © 2003 by The American Society of Tropical Medicine and Hygiene

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SHORT REPORT: PROXIMITY TO MOSQUITO BREEDING SITES AS A RISK FACTOR FOR CLINICAL MALARIA EPISODES IN AN URBAN COHORT OF UGANDAN CHILDREN

SARAH G. STAEDKE, E. WILLIS NOTTINGHAM, JONATHAN COX, MOSES R. KAMYA, PHILIP J. ROSENTHAL, AND GRANT DORSEY
Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; Makerere University Medical School, Kampala, Uganda; Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom

 

ABSTRACT

The impact of geography on incidence of clinical episodes of malaria was investigated in a cohort of children enrolled in a longitudinal clinical trial of antimalarial therapy in Kampala, Uganda. Participant households and the boundaries of local swamps and streams were mapped and incidence of clinical malaria episodes was measured prospectively using passive surveillance during one year of follow-up. Of 316 cohort participants, 305 from 219 households were followed for at least six weeks and were included in the analysis. Incidence of clinical malaria was highly variable, with no episodes occurring in 131 participants, and 367 new episodes of malaria diagnosed in the remaining 174 children. A gradient in incidence of clinical episodes of malaria was observed with distance of residence from a swamp (0.41 episodes per person year for residence >100 meters from a swamp increasing to 2.22 episodes per person year for residence within a swamp), or a stream (0.61 episodes per person year for residence >=500 meters from a stream versus 1.76 episodes per person year for residence <500 meters from a stream). Multivariate analysis showed that distances of residence from a swamp or from a stream were independent predictors of malaria incidence, controlling for age, use of preventative measures, and primary source of water. Distance from a swamp was the strongest predictor, with an incidence rate ratio of 4.3 (95% confidence interval = 2.6–6.9, P < 0.001) between residence within a swamp and >100 meters from a swamp. In this urban setting, incidence of clinical episodes of malaria was strongly associated with proximity of residence to potential mosquito breeding sites.

Received February 15, 2003. Accepted for publication May 27, 2003.

Acknowledgments: We thank the clinical study team of Marx Dongo, B. M. Karakire, Sam Nsobya, Moses Kiggundu, Christopher Bongole, Regina Nakafero, Denise Njama, Bridget K. Nzarubara, Pauline Byakika, and Sarah Kibirango; the community leaders from the Kawempe Division of Kampala; and the study participants and their parents/guardians.

Financial support: This study was supported by the Fogarty International Center/National Institutes of Health (grants TW00007, TW01506, and AI-43301), the UNDP/World Bank/World Health Organization Special Program for Research and Training in Tropical Diseases (TDR), the David E. Rogers Fellowship (New York Academy of Medicine), and the University of California, San Francisco, Rainer Fund.

Authors’ addresses: Sarah G. Staedke, E. Willis Nottingham, Philip J. Rosenthal, Grant Dorsey, Department of Medicine, University of California, San Francisco, San Francisco, CA 94143. Jonathan Cox, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom. Moses R. Kamya, Makerere University Medical School, Kampala, Uganda.

Reprint requests: Philip J. Rosenthal, Department of Medicine, University of California, San Francisco, Box 0811, San Francisco, CA 94143, Telephone: 415-206-8845, Fax: 415-648-8425, E-mail: rosnthl{at}itsa.ucsf.edu.




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