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

Sally Peprah Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland;

Search for other papers by Sally Peprah in
Current site
Google Scholar
PubMed Close
,
Constance Tenge Moi University College of Health Sciences, Eldoret, Kenya;

Search for other papers by Constance Tenge in
Current site
Google Scholar
PubMed Close
,
Isaiah O. Genga EMBLEM Study, Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya;

Search for other papers by Isaiah O. Genga in
Current site
Google Scholar
PubMed Close
,
Mediatrix Mumia EMBLEM Study, Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya;

Search for other papers by Mediatrix Mumia in
Current site
Google Scholar
PubMed Close
,
Pamela A. Were EMBLEM Study, Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya;

Search for other papers by Pamela A. Were in
Current site
Google Scholar
PubMed Close
,
Robert T. Kuremu Moi University College of Health Sciences, Eldoret, Kenya;

Search for other papers by Robert T. Kuremu in
Current site
Google Scholar
PubMed Close
,
Walter N. Wekesa Moi University College of Health Sciences, Eldoret, Kenya;

Search for other papers by Walter N. Wekesa in
Current site
Google Scholar
PubMed Close
,
Peter O. Sumba Kenya Medical Research Institute, Kisumu, Kenya;

Search for other papers by Peter O. Sumba in
Current site
Google Scholar
PubMed Close
,
Tobias Kinyera EMBLEM Study, African Field Epidemiology Network, Kampala, Uganda;

Search for other papers by Tobias Kinyera in
Current site
Google Scholar
PubMed Close
,
Isaac Otim EMBLEM Study, African Field Epidemiology Network, Kampala, Uganda;

Search for other papers by Isaac Otim in
Current site
Google Scholar
PubMed Close
,
Ismail D. Legason EMBLEM Study, African Field Epidemiology Network, Kampala, Uganda;

Search for other papers by Ismail D. Legason in
Current site
Google Scholar
PubMed Close
,
Joshua Biddle Stanford Hospitals and Clinics, University of Stanford, Pao Alto, California;

Search for other papers by Joshua Biddle in
Current site
Google Scholar
PubMed Close
,
Steven J. Reynolds National Institutes of Health/Uganda Project Entebbe, National Institute of Allergy and Infectious Diseases, Rockville, Maryland;

Search for other papers by Steven J. Reynolds in
Current site
Google Scholar
PubMed Close
,
Ambrose O. Talisuna World Health Organization, Regional Office for Africa, Brazzaville, Congo

Search for other papers by Ambrose O. Talisuna in
Current site
Google Scholar
PubMed Close
,
Robert J. Biggar Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland;

Search for other papers by Robert J. Biggar in
Current site
Google Scholar
PubMed Close
,
Kishor Bhatia Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland;

Search for other papers by Kishor Bhatia in
Current site
Google Scholar
PubMed Close
,
James J. Goedert Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland;

Search for other papers by James J. Goedert in
Current site
Google Scholar
PubMed Close
,
Ruth M. Pfeiffer Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland;

Search for other papers by Ruth M. Pfeiffer in
Current site
Google Scholar
PubMed Close
, and
Sam M. Mbulaiteye Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland;

Search for other papers by Sam M. Mbulaiteye in
Current site
Google Scholar
PubMed Close
DOI:
https://doi.org/10.4269/ajtmh.18-0481
Volume/Issue:
Volume 100: Issue 1
Page(s):
54–65
Restricted access
Get Permissions

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.

    • Supplemental Materials (PDF 21 KB)

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.

Deceased.

Copyright:
© The American Society of Tropical Medicine and Hygiene 2019
Received:
07 Jun 2018
|
Accepted:
07 Aug 2018
|
Published Online:
19 Nov 2018
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
  • 1.

    White NJ, Pukrittayakamee S, Hien TT, Faiz MA, Mokuolu OA, Dondorp AM, 2014. Malaria. Lancet 383: 723–735.

  • 2.

    World Health Organization, 2017. World Malaria Report 2017. Geneva, Switzerland: WHO. Available at: http://apps.who.int/iris/bitstream/handle/10665/259492/9789241565523-eng.pdf;jsessionid=78C722919AE7E766074B0161AC904208?sequence=1. Accessed April 20, 2017.

    • PubMed
    • Export Citation
  • 3.

    Snow RW, Sartorius B, Kyalo D, Maina J, Amratia P, Mundia CW, Bejon P, Noor AM, 2017. The prevalence of Plasmodium falciparum in sub-Saharan Africa since 1900. Nature 550: 515–518.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Kenya National Bureau of Statistics, 2015. National Top 10 Incidences of Diseases: 2009 to 2015. Available at: https://knbs.or.ke/visualizations/?page_id=3215. Accessed March 5, 2018.

    • PubMed
    • Export Citation
  • 5.

    Noor AM, Gething PW, Alegana VA, Patil AP, Hay SI, Muchiri E, Juma E, Snow RW, 2009. The risks of malaria infection in Kenya in 2009. BMC Infect Dis 9: 180.

  • 6.

    National Malaria Control Programme, 2015. Kenya Malaria Indicator Survey 2015. Available at: https://dhsprogram.com/pubs/pdf/MIS22/MIS22.pdf. Accessed April 20, 2017.

    • PubMed
    • Export Citation
  • 7.

    Goncalves BP et al. 2017. Examining the human infectious reservoir for Plasmodium falciparum malaria in areas of differing transmission intensity. Nat Commun 8: 1133.

  • 8.

    Lindblade KA, Steinhardt L, Samuels A, Kachur SP, Slutsker L, 2013. The silent threat: asymptomatic parasitemia and malaria transmission. Expert Rev Anti Infect Ther 11: 623–639.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Galatas B, Bassat Q, Mayor A, 2016. Malaria parasites in the asymptomatic: looking for the hay in the Haystack. Trends Parasitol 32: 296–308.

  • 10.

    Walldorf JA et al. 2015. School-age children are a reservoir of malaria infection in Malawi. PLoS One 10: e0134061.

  • 11.

    Zhou Z et al. 2016. Assessment of submicroscopic infections and gametocyte carriage of Plasmodium falciparum during peak malaria transmission season in a community-based cross-sectional survey in western Kenya, 2012. Malar J 15: 421.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Coalson JE et al. 2016. High prevalence of Plasmodium falciparum gametocyte infections in school-age children using molecular detection: patterns and predictors of risk from a cross-sectional study in southern Malawi. Malar J 15: 527.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Robinson A et al. 2018. Plasmodium-associated changes in human odor attract mosquitoes. Proc Natl Acad Sci USA 115: E4209–E4218.

  • 14.

    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: 267–270.

  • 15.

    Platt A, Obala AA, MacIntyre C, Otsyula B, Meara WPO, 2018. Dynamic malaria hotspots in an open cohort in western Kenya. Sci Rep 8: 647.

  • 16.

    The malERA Refresh Consultative Panel on Characterising the Reservoir and Measuring Transmission, 2017. malERA: an updated research agenda for characterising the reservoir and measuring transmission in malaria elimination and eradication. PLoS Med 14: e1002452.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Legason ID et al. 2017. Evaluating the causal link between malaria infection and endemic Burkitt lymphoma in northern Uganda: a mendelian randomization study. EBioMedicine 25: 58–65.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Ernst KC, Adoka SO, Kowuor DO, Wilson ML, John CC, 2006. Malaria hotspot areas in a highland Kenya site are consistent in epidemic and non-epidemic years and are associated with ecological factors. Malar J 5: 78.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    O’Reilly CE et al. 2012. Risk factors for death among children less than 5 years old hospitalized with diarrhea in rural western Kenya, 2005–2007: a cohort study. PLoS Med 9: e1001256.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Kipanga PN, Omondi D, Mireji PO, Sawa P, Masiga DK, Villinger J, 2014. High-resolution melting analysis reveals low Plasmodium parasitaemia infections among microscopically negative febrile patients in western Kenya. Malar J 13: 429.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Kepha S et al. 2016. Plasmodium falciparum parasitaemia and clinical malaria among school children living in a high transmission setting in western Kenya. Malar J 15: 157.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Stevenson JC et al. 2013. Reliability of school surveys in estimating geographic variation in malaria transmission in the western Kenyan highlands. PLoS One 8: e77641.

  • 23.

    Simbiri KO et al. 2014. Burkitt lymphoma research in east Africa: highlights from the 9(th) African organization for research and training in cancer conference held in Durban, South Africa in 2013. Infect Agent Cancer 9: 32.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Minakawa N, Sonye G, Mogi M, Githeko A, Yan G, 2002. The effects of climatic factors on the distribution and abundance of malaria vectors in Kenya. J Med Entomol 39: 833–841.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Maziarz M et al. 2017. Age and geographic patterns of Plasmodium falciparum malaria infection in a representative sample of children living in Burkitt lymphoma-endemic areas of northern Uganda. Malar J 16: 124.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Kenya National Bureau of Statistics, 2013. Overview of Census 2009. Available at: https://www.knbs.or.ke/overview-of-census-2009/. Accessed April 16, 2018.

    • PubMed
    • Export Citation
  • 27.

    World Health Organization, 2015. WHO Prequalification of in vitro Diagnostics Programmes Public Report Product: CareStart™ Malaria HRP2/pLDH (Pf/PAN) COMBO Number: PQDx 0136-049-00. Geneva, Switzerland: WHO. Available at: http://www.who.int/diagnostics_laboratory/evaluations/150528_final_report_0136_049_00_malaria_hrp2pldh_pfpan.pdf.

    • PubMed
    • Export Citation
  • 28.

    Ochola LB, Vounatsou P, Smith T, Mabaso ML, Newton CR, 2006. The reliability of diagnostic techniques in the diagnosis and management of malaria in the absence of a gold standard. Lancet Infect Dis 6: 582–588.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Wongsrichanalai C, Barcus MJ, Muth S, Sutamihardja A, Wernsdorfer WH, 2007. A review of malaria diagnostic tools: microscopy and rapid diagnostic test (RDT). Am J Trop Med Hyg 77: 119–127.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    World Health Organization Informal Consultation on Recent Advances in Diagnostic Techniques and Vaccines for Malaria, 1996. A rapid dipstick antigen capture assay for the diagnosis of falciparum malaria. WHO informal consultation on recent advances in diagnostic techniques and vaccines for malaria. Available at: http://www.who.int/iris/handle/10665/49976Bull World Health Organ 74: 47–54. Accessed April 20, 2017.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Beadle C, Long GW, Weiss WR, McElroy PD, Maret SM, Oloo AJ, Hoffman SL, 1994. Diagnosis of malaria by detection of Plasmodium falciparum HRP-2 antigen with a rapid dipstick antigen-capture assay. Lancet 343: 564–568.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Mayxay M, Pukrittayakamee S, Chotivanich K, Looareesuwan S, White NJ, 2001. Persistence of Plasmodium falciparum HRP-2 in successfully treated acute falciparum malaria. Trans R Soc Trop Med Hyg 95: 179–182.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Schellenberg JR, Smith T, Alonso PL, Hayes RJ, 1994. What is clinical malaria? Finding case definitions for field research in highly endemic areas. Parasitol Today 10: 439–442.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34.

    Rainey JJ, Omenah D, Sumba PO, Moormann AM, Rochford R, Wilson ML, 2007. Spatial clustering of endemic Burkitt’s lymphoma in high-risk regions of Kenya. Int J Cancer 120: 121–127.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35.

    Kafuko GW, Burkitt DP, 1970. Burkitt’s lymphoma and malaria. Int J Cancer 6: 1–9.

  • 36.

    Morrow RH Jr., 1985. Epidemiological evidence for the role of falciparum malaria in the pathogenesis of Burkitt’s lymphoma. IARC Sci Publ 60: 177–186.

  • 37.

    Emmanuel B et al. 2011. African Burkitt lymphoma: age-specific risk and correlations with malaria biomarkers. Am J Trop Med Hyg 84: 397–401.

  • 38.

    Buckle G et al. 2016. Factors influencing survival among Kenyan children diagnosed with endemic Burkitt lymphoma between 2003 and 2011: a historical cohort study. Int J Cancer 139: 1231–1240.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39.

    Rodriguez-Barraquer I et al. 2016. Quantifying heterogeneous malaria exposure and clinical protection in a cohort of Ugandan children. J Infect Dis 214: 1072–1080.

  • 40.

    Johnston WT et al. 2014. Relationship between Plasmodium falciparum malaria prevalence, genetic diversity and endemic Burkitt lymphoma in Malawi. Sci Rep 4: 3741.

  • 41.

    Noor AM, Amin AA, Akhwale WS, Snow RW, 2007. Increasing coverage and decreasing inequity in insecticide-treated bed net use among rural Kenyan children. PLoS Med 4: e255.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 42.

    Fillinger U, Ndenga B, Githeko A, Lindsay SW, 2009. Integrated malaria vector control with microbial larvicides and insecticide-treated nets in western Kenya: a controlled trial. Bull World Health Organ 87: 655–665.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 43.

    Gimnig JE et al. 2016. The effect of indoor residual spraying on the prevalence of malaria parasite infection, clinical malaria and anemia in an area of perennial transmission and moderate coverage of insecticide treated nets in western Kenya. PLoS One 11: e0145282.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 44.

    Steinhardt LC et al. 2013. The effect of indoor residual spraying on malaria and anemia in a high-transmission area of northern Uganda. Am J Trop Med Hyg 88: 855–861.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 45.

    Rek JC et al. 2018. Rapid improvements to rural Ugandan housing and their association with malaria from intense to reduced transmission: a cohort study. Lancet Planet Health 2: e83–e94.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 46.

    Dida GO, Anyona DN, Abuom PO, Akoko D, Adoka SO, Matano AS, Owuor PO, Ouma C, 2018. Spatial distribution and habitat characterization of mosquito species during the dry season along the Mara River and its tributaries, in Kenya and Tanzania. Infect Dis Poverty 7: 2.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 47.

    Zhou G, Munga S, Minakawa N, Githeko AK, Yan G, 2007. Spatial relationship between adult malaria vector abundance and environmental factors in western Kenya highlands. Am J Trop Med Hyg 77: 29–35.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 48.

    Hamer GL et al. 2014. Dispersal of adult Culex mosquitoes in an urban west Nile virus hotspot: a mark-capture study incorporating stable isotope enrichment of natural larval habitats. PLoS Negl Trop Dis 8: e2768.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 49.

    Collins WE, Warren M, Sullivan JS, Galland GG, 2001. Plasmodium coatneyi: observations on periodicity, mosquito infection, and transmission to Macaca mulatta monkeys. Am J Trop Med Hyg 64: 101–110.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 50.

    Donnelly B, Berrang-Ford L, Ross NA, Michel P, 2015. A systematic, realist review of zooprophylaxis for malaria control. Malar J 14: 313.

  • 51.

    Kaburi JC, Githuto JN, Muthami L, Ngure PK, Mueke JM, Mwandawiro CS, 2009. Effects of long-lasting insecticidal nets and zooprophylaxis on mosquito feeding behaviour and density in Mwea, central Kenya. J Vector Borne Dis 46: 184–190.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 52.

    Sota T, Mogi M, 1989. Effectiveness of zooprophylaxis in malaria control: a theoretical inquiry, with a model for mosquito populations with two bloodmeal hosts. Med Vet Entomol 3: 337–345.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 53.

    Bouma M, Rowland M, 1995. Failure of passive zooprophylaxis: cattle ownership in Pakistan is associated with a higher prevalence of malaria. Trans R Soc Trop Med Hyg 89: 351–353.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 54.

    Iwashita H, Dida GO, Sonye GO, Sunahara T, Futami K, Njenga SM, Chaves LF, Minakawa N, 2014. Push by a net, pull by a cow: can zooprophylaxis enhance the impact of insecticide treated bed nets on malaria control? Parasit Vectors 7: 52.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 55.

    Githinji S, Noor AM, Malinga J, Macharia PM, Kiptui R, Omar A, Njagi K, Waqo E, Snow RW, 2016. A national health facility survey of malaria infection among febrile patients in Kenya, 2014. Malar J 15: 591.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 56.

    Brooker S, Kolaczinski JH, Gitonga CW, Noor AM, Snow RW, 2009. The use of schools for malaria surveillance and programme evaluation in Africa. Malar J 8: 231.

  • 57.

    Mala AO, Irungu LW, Shililu JI, Muturi EJ, Mbogo CM, Njagi JK, Mukabana WR, Githure JI, 2011. Plasmodium falciparum transmission and aridity: a Kenyan experience from the dry lands of Baringo and its implications for Anopheles arabiensis control. Malar J 10: 121.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 58.

    Nah K, Kim Y, Lee JM, 2010. The dilution effect of the domestic animal population on the transmission of P. vivax malaria. J Theor Biol 266: 299–306.

  • 59.

    Wanzira H, Kakuru A, Arinaitwe E, Bigira V, Muhindo MK, Conrad M, Rosenthal PJ, Kamya MR, Tappero JW, Dorsey G, 2014. Longitudinal outcomes in a cohort of Ugandan children randomized to artemether-lumefantrine versus dihydroartemisinin-piperaquine for the treatment of malaria. Clin Infect Dis 59: 509–516.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 60.

    Githinji S, Herbst S, Kistemann T, Noor AM, 2010. Mosquito nets in a rural area of western Kenya: ownership, use and quality. Malar J 9: 250.

Past two years Past Year Past 30 Days
Abstract Views 3736 3342 744
Full Text Views 1296 15 1
PDF Downloads 231 12 0
 

 

 

 
 
Affiliate Membership Banner
 
 
Research for Health Information Banner
 
 
CLOCKSS
 
 
 
Society Publishers Coalition Banner
Save