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Disclaimer: The content of this report is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funders of this study did not participate in the study design, data collection, data analysis, and data interpretation or writing of findings.
Disclosures: All authors have not reported any conflict of interest and have submitted the ICMJE form for disclosure of potential conflict of interest.
Financial support: This work was supported by the Fogarty International Centers of the National Institutes of Health under Award number D43TW010526 and D43TW7375. J. I. N. is supported by the Fogarty International Center (Emerging Global Leader Award grant number K43TW010365).
Authors’ addresses: Emmanuel Arinaitwe, Chris Drakeley, and Sarah Staedke, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom, E-mails: [email protected], [email protected], and [email protected]. Arthur Mpimbaza, Joaniter I. Nankabirwa, and Moses R. Kamya, Makerere University and the Infectious Diseases Research Collaboration, Kampala, Uganda, E-mails: [email protected], [email protected], and [email protected]. Victor Kamya and Alan Asiimwe, Infectious Diseases Research Collaboration, Kampala, Uganda, E-mail: [email protected] and [email protected]. Julius K. Kuule, Uganda Malaria Research Centre, Ministry of Health, Kampala, Uganda, E-mail: [email protected].
Abstract.
Malaria is frequently diagnosed in urban Kampala, despite low transmission intensity. To evaluate the association between recent travel out of Kampala and malaria, we conducted a matched case–control study. Cases were febrile outpatients with a positive malaria test; controls were febrile outpatients with a negative test. For every two cases, five controls were selected, matching on age. Data were collected on recent overnight travel out of Kampala (past 60 days), destination and duration of travel, and behavioral factors, including sleeping under an insecticide-treated net (ITN) during travel. From July to August 2019, 162 cases and 405 controls were enrolled. The locations of residence of cases and controls were similar. More controls were female (62.7% versus 46.3%, P < 0.001). Overall, 158 (27.9%) participants reported recent overnight travel. Travelers were far more likely to be diagnosed with malaria than those who did not travel (80.4% versus 8.6%, OR 58.9, 95% CI: 23.1–150.1, P < 0.001). Among travelers, traveling to a district not receiving indoor residual spraying of insecticide (OR 35.0, 95% CI: 4.80–254.9, P < 0.001), no ITN use (OR 30.1, 95% CI: 6.37–142.7, P < 0.001), engaging in outdoor activities (OR 22.0, 95% CI: 3.42–141.8, P = 0.001), and age < 16 years (OR 8.36, 95% CI: 2.22–56.2, P = 0.03) were associated with increased odds of malaria. Kampala residents who traveled overnight out of the city were at substantially higher risk of malaria than those who did not travel. For these travelers, personal protection measures, including sleeping under an ITN when traveling, should be advocated.