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We conducted a health facility-based survey of patients with fever during malaria transmission season to determine the proportion with laboratory-confirmed malaria in Luanda, Angola. We enrolled 864 patients at 30 facilities; each underwent a blood film for malaria and a questionnaire. Only 3.6% had a positive blood film. When stratified by distance of the facility to city center (< 15 km and 
15 km), the proportions were 1.5% (9/615) and 8.8% (22/249), respectively (P < 0.0001). Of patients traveling outside Luanda in the preceding 3 months, 6.8% (6/88) had malaria, compared with 3.2% (26/776) not traveling (P = 0.13). Children < 5 years of age were less likely to have malaria (2.4%; 12/510) than children ages 5–14 (8.7%; 9/104) and adults (4.0%; 10/250) (P = 0.03). The prevalence of laboratory-confirmed malaria in febrile patients in Luanda is very low, but increases with distance from the urban center. Prevention and treatment should be focused in surrounding rural areas.
Received September 29, 2008. Accepted for publication December 4, 2008.
Acknowledgments: We thank all the clinical and laboratory staff who worked tirelessly and painstakingly to assure the highest quality of data collection and patient care. We are grateful to the Provincial Health Department, Luanda, the National Institute of Public Health, and the National Malaria Control Program for their enthusiastic support. Josefa Gomes and Joceline Vasconcelos provided excellent translation services, Amy Ratcliffe, Gabriel Ponce de Leon, Jodi Vanden Eng, and John Williamson gave guidance in protocol development and statistical support, and Adam Wolkon helped with PDA programming. We also thank Susan Brems and the staff at USAID Angola for their support, Research Triangle International for their assistance, and Population Services International and UNICEF for their assistance in obtaining information about Luanda. Christian Lengeler and Michael Guterbock allowed us to use their materials for questionnaire development. Most of all, we are indebted to the directors and staff of the clinics that participated, and all the patients who gave their time.
Financial support: Funding was provided by the President’s Malaria Initiative through support provided by the Office of Health, Infectious Diseases, and Nutrition, Bureau for Global Health, U.S. Agency for International Development, under the terms of an Interagency Agreement with Centers for Disease Control and Prevention. The opinions expressed herein are those of the authors and do not necessarily reflect the views of the U.S. Agency for International Development or of the Centers for Disease Control and Prevention.
Disclosures: Two of the authors are employed by the President’s Malaria Initiative, which funded this study. This statement is made in the interest of full disclosure and not because the authors consider this to be a conflict of interest.
* Address correspondence to Julie Thwing, Malaria Branch, Centers for Disease Control and Prevention, 4770 Buford Highway MSF-22, Atlanta, GA 30341. E-mail: jthwing{at}cdc.gov
Authors’ addresses: Julie Thwing, Alexandre Macedo de Oliveira, and Robert D. Newman, Malaria Branch, Centers for Disease Control and Prevention, 4770 Buford Highway MSF-22, Atlanta, GA 30341, Tel: 770-488-7745, E-mails: jthwing{at}cdc.gov, acq7{at}cdc.gov, and rnewman{at}cdc.gov. Jules Mihigo and Francisco Saute, USAID/PMI/ Angola, Rua Houari Bomedienne, # 32, Luanda, Angola, E-mails: jmihigo{at}cdc.gov and fsaute{at}usaid.gov. Alexandra P. Fernandez, PO Box 125, Luanda, Angola. Carolina Ferreira, PO Box 3665, Luanda, Angola. Filomeno Fortes, National Malaria Control Program, PO Box 1201 Luanda, Angola.
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