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A Cross-Sectional Population Study of Geographic, Age-Specific, and Household Risk Factors for Asymptomatic Plasmodium falciparum Malaria Infection in Western Kenya

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  • 1 Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland;
  • | 2 Moi University College of Health Sciences, Eldoret, Kenya;
  • | 3 EMBLEM Study, Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya;
  • | 4 Kenya Medical Research Institute, Kisumu, Kenya;
  • | 5 EMBLEM Study, African Field Epidemiology Network, Kampala, Uganda;
  • | 6 Stanford Hospitals and Clinics, University of Stanford, Pao Alto, California;
  • | 7 National Institutes of Health/Uganda Project Entebbe, National Institute of Allergy and Infectious Diseases, Rockville, Maryland;
  • | 8 World Health Organization, Regional Office for Africa, Brazzaville, Congo

The burden of Plasmodium falciparum (Pf) malaria in Kenya is decreasing; however, it is still one of the top 10 causes of morbidity, particularly in regions of western Kenya. Between April 2015 and June 2016, we enrolled 965 apparently healthy children aged 0–15 years in former Nyanza and Western Provinces in Kenya to characterize the demographic, geographic, and household risk factors of asymptomatic malaria as part of an epidemiologic study to investigate the risk factors for endemic Burkitt lymphoma. The children were sampled using a stratified, multistage cluster sampling survey design. Malaria was assessed by rapid diagnostic test (RDT) and thick-film microscopy (TFM). Primary analyses of Pf malaria prevalence (pfPR) are based on RDT. Associations between weighted pfPR and potential risk factors were evaluated using logistic regression, accounting for the survey design. Plasmodium falciparum malaria prevalence was 36.0% (27.5%, 44.5%) by RDT and 22.3% (16.0%, 28.6%) by TFM. Plasmodium falciparum malaria prevalence was positively associated with living in the lake-endemic area (adjusted odds ratio [aOR] 3.46; 95% confidence interval [95% CI] 1.63, 7.37), paternal occupation as peasant farmer (aOR 1.87; 1.08, 3.26) or manual laborer (aOR 1.83; 1.00, 3.37), and keeping dogs (aOR 1.62; 0.98–2.69) or cows (aOR 1.52; 0.96–2.40) inside or near the household. Plasmodium falciparum malaria prevalence was inversely associated with indoor residual insecticide spraying (IRS) (aOR 0.44; 0.19, 1.01), having a household connected to electricity (aOR 0.47; 0.22, 0.98), and a household with two (aOR 0.45; 0.22, 0.93) or ≥ three rooms (aOR 0.41; 0.18, 0.93). We report high but geographically heterogeneous pfPR in children in western Kenya and significant associations with IRS and household-level socioeconomic factors.

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Author Notes

Address correspondence to Sam M. Mbulaiteye, Division of Cancer Epidemiology and Genetics, Infections and Immunoepidemiology Branch, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, 9609 Medical Center Dr., Rm. 6E-118, MSC 3330, Bethesda, MD 20892. E-mail: mbulaits@mail.nih.gov

Financial support: This study was funded by the Intramural Research Program of the Division of Cancer Epidemiology and Genetics, National Cancer Institute (NCI) (Contracts HHSN261201100063C and HHSN261201100007I) and, in part, by the Intramural Research Program, National Institute of Allergy and Infectious Diseases (S. J. R.), National Institutes of Health, Department of Health and Human Services. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. The content of this manuscript is the sole responsibility of the authors.

Authors’ addresses: Sally Peprah, Robert J. Biggar, Kishor Bhatia, James J. Goedert, Ruth M. Pfeiffer, and Sam M. Mbulaiteye, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, E-mails: sally.peprah@nih.gov, rjbiggar@gmail.com, bhatiak@cgix.com, goedertj@mail.nih.gov, pfeiffer@mail.nih.gov, and mbulaits@mail.nih.gov. Constance Tenge, Robert T. Kuremu, and Walter N. Wekesa, Moi University College of Health Sciences, Eldoret, Kenya, E-mails: cntenge@yahoo.co.uk, robkum2002@gmail.com, and wekesan@yahoo.com. Isaiah O. Genga, Mediatrix Mumia, and Pamela A. Were, EMBLEM Study, AMPATH, Eldoret, Kenya, E-mails: ourogenga@gmail.com, mediatrixmumia@yahoo.com, and aki_otieno2@yahoo.co.uk. Tobias Kinyera, Isaac Otim, and Ismail D. Legason, EMBLEM Study, African Field Epidemiology Network, Kampala, Uganda and St. Mary’s Hospital, Lacor, Gulu, Uganda, E-mails: tobiaskinyera@gmail.com, isaakotim@gmail.com, and legason2k@yahoo.com. Joshua Biddle (Dr. Biddle worked on the EMBLEM Study as a US Fulbright Scholar in Kenya in 2014), Stanford Hospitals and Clinics, University of Stanford, Pao Alto, CA, E-mail: jbiddle@stanford.edu. Steven J. Reynolds, National Institute of Health/Uganda Project Entebbe, National Institute of Allergy and Infectious Diseases, Rockville, MD, E-mail: sjr@jhmi.edu. Ambrose O. Talisuna, World Health Organization, Regional Office for Africa, Brazzaville, Congo, E-mail: atalisuna@yahoo.com.

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