Volume 94, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Nairobi is considered a low-risk area for malaria transmission, but travel can influence transmission of malaria. We investigated the demographic characteristics and travel history of patients with documented fever and malaria in a study clinic in a population-based surveillance system over a 5-year period, January 1, 2007 to December 31, 2011. During the study period, 11,480 (68%) febrile patients had a microscopy test performed for malaria, of which 2,553 (22%) were positive. Malaria was detected year-round with peaks in January, May, and September. Children aged 5–14 years had the highest proportion (28%) of positive results followed by children aged 1–4 years (23%). Almost two-thirds of patients with malaria reported traveling outside Nairobi; 79% of these traveled to three counties in western Kenya. History of recent travel (i.e., in past month) was associated with malaria parasitemia (odds ratio: 10.0, 95% confidence interval: 9.0–11.0). Malaria parasitemia was frequently observed among febrile patients at a health facility in the urban slum of Kibera, Nairobi. The majority of patients had traveled to western Kenya. However, 34% reported no travel history, which raises the possibility of local malaria transmission in this densely populated, urban setting. These findings have important implications for malaria control in large Nairobi settlements.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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  1. Eisele TP, Larsen DA, Walker N, Cibulskis RE, Yukich JO, Zikusooka CM, Steketee RW, , 2012. Estimates of child deaths prevented from malaria prevention scale-up in Africa 2001–2010. Malar J 11: 93.[Crossref]
  2. Pigott DM, Atun R, Moyes CL, Hay SI, Gething PW, , 2012. Funding for malaria control 2006–2010: a comprehensive global assessment. Malar J 11: 246.[Crossref]
  3. WHO, 2012. World Malaria Report 2012. Available at: http://www.who.int/malaria/publications/world_malaria_report_2012/wmr2012_full_report.pdf. Accessed January 23, 2015.
  4. DoMC, 2013. Kenya Annual Malaria Report 2012/2013. Nairobi, Kenya: Division of Malaria Control.
  5. MoPHS, 2011. 2010 Kenya Malaria Indicator Survey. Available at: http://measuredhs.com/pubs/pdf/MIS7/MIS7.pdf. Accessed August 17, 2015.
  6. MoPHS, 2009. National Malaria Strategy, 2009–2017. Available at: http://www.c-hubonline.org/sites/default/files/resources/main/Kenya_National_Malaria_Strategy_2009-2017.pdf. Accessed August 17, 2015.
  7. Martens P, Hall L, , 2000. Malaria on the move: human population movement and malaria transmission. Emerg Infect Dis 6: 103109.[Crossref]
  8. Lynch C, Roper C, , 2011. The transit phase of migration: circulation of malaria and its multidrug-resistant forms in Africa. PLoS Med 8: e1001040.[Crossref]
  9. Bureau Population Reference, 2011. Kenya Population Data Sheet 2011. Available at: http://www.prb.org/Publications/Datasheets/2011/kenya-population-data-sheet-2011.aspx. Accessed August 17, 2015.
  10. Wesolowski A, Eagle N, Tatem AJ, Smith DL, Noor AM, Snow RW, Buckee CO, , 2012. Quantifying the impact of human mobility on malaria. Science 338: 267270.[Crossref]
  11. Okara RM, Sinka ME, Minakawa N, Mbogo CM, Hay SI, Snow RW, , 2010. Distribution of the main malaria vectors in Kenya. Malar J 9: 69.[Crossref]
  12. Cotter C, Sturrock HJ, Hsiang MS, Liu J, Phillips AA, Hwang J, Gueye CS, Fullman N, Gosling RD, Feachem RG, , 2013. The changing epidemiology of malaria elimination: new strategies for new challenges. Lancet 382: 900911.[Crossref]
  13. Lynch CA, Bruce J, Bhasin A, Roper C, Cox J, Abeku TA, , 2015. Association between recent internal travel and malaria in Ugandan highland and highland fringe areas. Trop Med Int Health 20: 773780.[Crossref]
  14. Pindolia DK, Garcia AJ, Huang Z, Smith DL, Alegana VA, Noor AM, Snow RW, Tatem AJ, , 2013. The demographics of human and malaria movement and migration patterns in east Africa. Malar J 12: 397.[Crossref]
  15. Feikin DR, Olack B, Bigogo GM, Audi A, Cosmas L, Aura B, Burke H, Njenga MK, Williamson J, Breiman RF, , 2011. The burden of common infectious disease syndromes at the clinic and household level from population-based surveillance in rural and urban Kenya. PLoS One 6: e16085.[Crossref]
  16. Mudhune SA, Okiro EA, Noor AM, Zurovac D, Juma E, Ochola SA, Snow RW, , 2011. The clinical burden of malaria in Nairobi: a historical review and contemporary audit. Malar J 10: 138.[Crossref]
  17. Topographic-map.com, 2015. Topographic Map: Kibera. Available at: http://en-ca.topographic-map.com/places/Kibera-2908396/. Accessed October 8, 2015.
  18. Bayoh MN, Mathias DK, Odiere MR, Mutuku FM, Kamau L, Gimnig JE, Vulule JM, Hawley WA, Hamel MJ, Walker ED, , 2010. Anopheles gambiae: historical population decline associated with regional distribution of insecticide-treated bed nets in western Nyanza Province, Kenya. Malar J 9: 62.[Crossref]
  19. Suchdev PS, Davis SM, Bartoces M, Ruth LJ, Worrell CM, Kanyi H, Odero K, Wiegand RE, Njenga SM, Montgomery JM, Fox LM, , 2014. Soil-transmitted helminth infection and nutritional status among urban slum children in Kenya. Am J Trop Med Hyg 90: 299305.[Crossref]
  20. Feikin DR, Audi A, Olack B, Bigogo GM, Polyak C, Burke H, Williamson J, Breiman RF, , 2010. Evaluation of the optimal recall period for disease symptoms in home-based morbidity surveillance in rural and urban Kenya. Int J Epidemiol 39: 450458.[Crossref]
  21. MoPHS, 2012. National Guidelines for the Diagnosis, Treatment and Prevention of Malaria in Kenya. Available at: http://www.thehealthcompass.org/sites/default/files/project_examples/Kenya_Malaria_Tx_Guideline_2010.pdf. Accessed August 17, 2015.
  22. WHO, 2009. Malaria Microscopy Quality Assurance Manual Version 1. Available at: http://www.who.int/malaria/publications/malaria_microscopy_QA_manual.pdf. Accessed August 17, 2015.
  23. WHO, 2010. Basic Malaria Microscopy Part I Learner's Guide. Available at: http://whqlibdoc.who.int/publications/2010/9789241547826_eng.pdf. Accessed August 17, 2015.
  24. Kasili S, Odemba N, Ngere FG, Kamanza JB, Muema AM, Kutima HL, , 2009. Entomological assessment of the potential for malaria transmission in Kibera slum of Nairobi, Kenya. J Vector Borne Dis 46: 273279.
  25. Loevinsohn ME, , 1994. Climatic warming and increased malaria incidence in Rwanda. Lancet 343: 714718.[Crossref]
  26. Siraj AS, Santos-Vega M, Bouma MJ, Yadeta D, Ruiz Carrascal D, Pascual M, , 2014. Altitudinal changes in malaria incidence in highlands of Ethiopia and Colombia. Science 343: 11541158.[Crossref]
  27. Hay SI, Rogers DJ, Randolph SE, Stern DI, Cox J, Shanks GD, Snow RW, , 2002. Hot topic or hot air? Climate change and malaria resurgence in east African highlands. Trends Parasitol 18: 530534.[Crossref]
  28. BBC Weather, 2015. Weather Nairobi, Average Conditions. Available at: http://www.bbc.com/weather/184745. Accessed August 17, 2015.
  29. UNEP, 2009. Kenya Atlas of Our Changing Environment. Available at: http://www.unep.org/pdf/Kenya_Atlas_Full_EN_72dpi.pdf. Accessed August 2015.
  30. Arez AP, Snounou G, Pinto J, Sousa CA, Modiano D, Ribeiro H, Franco AS, Alves J, do Rosario VE, , 1999. A clonal Plasmodium falciparum population in an isolated outbreak of malaria in the Republic of Cabo Verde. Parasitology 118: 347355.[Crossref]
  31. MoPHS, 2009. Kenya Malaria Monitoring and Evaluation Plan 2009–2017. Available at: http://www.c-hubonline.org/sites/default/files/resources/monitoring-evaluation/Kenya_Malaria_M%26E_PLan_2009-2017.pdf. Accessed August 17, 2015.

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  • Received : 15 Apr 2015
  • Accepted : 18 Sep 2015

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