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TRAVEL HISTORIES AS RISK FACTORS IN THE ANALYSIS OF URBAN MALARIA IN COLOMBIA

Self-reported travel histories were used in a case-control study to determine whether movement of local residents to neighboring endemic areas was a risk factor for malaria in the town of Quibdo, Colombia. Multivariate analyses showed that among residents of Quibdo, traveling to an endemic area 8–14 days before disease onset was the strongest risk factor for both Plasmodium falciparum (adjusted odds ratio [OR] = 28.96, 95% confidence interval [CI] = 13.9–60.32) and P. vivax (adjusted OR = 14.24, 95% CI = 5.27–38.46) malaria. For P. falciparum, individuals who did not travel outside Quibdo during the 8–14 days before disease onset, but who reported traveling 1–7, 15–21, or 22–30 days before disease onset also had an increased risk of malaria. Conversely, use of protection against mosquitoes was negatively associated with P. falciparum. These results highlight the need for malaria control measures that target mobile populations. A definition of imported malaria that allows distinction of imported from autochthonous cases in Quibdo town is proposed.

Received November 21, 2003. Accepted for publication April 22, 2004.

Acknowledgments: We acknowledge the help and cooperation of the health authorities of Choco department and Quibdo municipality, and the personnel of the public and private health facilities during the conduction of the study. We are grateful to Dr. Iveth Gonzalez, Dr. Maria Helena Chacon, Rubiela Giraldo, the field workers, and the individuals who participated in the study.

Financial support: This study was supported by the United Nations Children’s Fund/United Nations Development Program/World Bank/World Health Organization Special Program for Research and Training in Tropical Diseases contract no. M8/181/4/O184. Lyda Osorio received a training grant from the Instituto Colombiano para el De-sarrollo de la Ciencia y la Tecnologia Francisco Jose de Caldas, and David J. Bradley is a member of the United Kingdom Department for International Development Research Program on Malaria Control.

Authors’ addresses: Lyda Osorio, International Center for Medical Research and Training, Avenida 1, Norte #3-03, Cali, Colombia, Telephone: 57-2-668-2164, Fax: 57-2-667-2989, E-mail: lyda.osorio{at}lshtm,ac.uk. Jim Todd and David J. Bradley, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom, Telephone: 44-20-7612-7870, Fax: 44-20-7636-8739, E-mail: jim. todd{at}lshtm.ac.uk, Telephone: 44-20-7927-2233, Fax: 44-20-7580-9075, E-mail: david.bradley{at}lshtm.ac.uk.

Reprints requests: Lyda Osorio, International Center for Medical Research and Training, Avenida 1, Norte #3-03, Cali, Colombia.

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