ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
World Health Organization , 2021. Malaria. Available at: https://www.who.int/news-room/fact-sheets/detail/malaria. Accessed January 24, 2022.
-
2.
Centers for Disease Control and Prevention , 2019. CDC in Zambia. Available at: https://www.cdc.gov/globalhealth/countries/zambia/default.htm. Accessed April 10, 2022.
-
3.
Inambao AB, Kumar R, Hamainza B, Makasa M, Nielsen CF, 2017. Malaria incidence in Zambia, 2013 to 2015: observations from the health management information system. Health Press Zambia Bull 1: 11–19.
-
4.
Troeger C et al.2018. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of diarrhoea in 195 countries: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Infect Dis 18: 1211–1228.
-
5.
Mulambya NL, Nanzaluka FH, Sinyangwe NN, Makasa M, 2020. Trends and factors associated with acute respiratory infection among under five children in Zambia: evidence from Zambia's demographic and health surveys (1996–2014). Pan Afr Med J 36: 1–13.
-
6.
Merera AM , 2021. Determinants of acute respiratory infection among under-five children in rural Ethiopia. BMC Infect Dis 21: 1203.
-
7.
Loevinsohn G et al., 2021. Facility-based surveillance for influenza and respiratory syncytial virus in rural Zambia. BMC Infect Dis 21: 1–13.
-
8.
Vogt RL, LaRue D, Klaucke DN, Jillson DA , 1983. Comparison of an active and passive surveillance system of primary care providers for hepatitis, measles, rubella, and salmonellosis in Vermont. Am J Public Health 73: 795–797.
-
9.
Kobayashi T, Kanyangarara M, Laban NM, Phiri M, Hamapumbu H, Searle KM, Stevenson JC, Thuma PE, Moss WJ , 2019. Characteristics of subpatent malaria in a pre-elimination setting in southern Zambia. Am J Trop Med Hyg 100: 280–286.
-
10.
Ren L, Xiang Z, Guo L, Wang J , 2012. Viral infections of the lower respiratory tract. Curr Infect Dis Rep 14: 284–291.
-
11.
Bado AR, Susuman AS, Nebie EI , 2016. Trends and risk factors for childhood diarrhea in sub-Saharan countries (1990–2013): assessing the neighborhood inequalities. Glob Health Action 9: 30166.
-
12.
Walker CLF, Rudan I, Liu L, Nair H, Theodoratou E, Bhutta ZA, O’Brien KL, Campbell H, Black RE , 2013. Global burden of childhood pneumonia and diarrhoea. Lancet 381: 1405–1416.
-
13.
Stekelenburg J, Kashumba E, Wolffers I , 2002. Factors contributing to high mortality due to pneumonia among under-fives in Kalabo District, Zambia. Trop Med Int Health 7: 886–893.
-
14.
Shier RP, Dollimore N, Ross DA, Binka FN, Quigley M, Smith PG , 1996. Drinking water sources, mortality and diarrhea morbidity among young children in northern Ghana. Trop Med Int Health 1: 334–341.
-
15.
R Core Team , 2021. R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing.
-
16.
Zhang D et al.2014. Epidemiology characteristics of respiratory viruses found in children and adults with respiratory tract infections in southern China. Int J Infect Dis 25: 159–164.
-
17.
GBD 2016 Lower Respiratory Infections Collaborators , 2018. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Infect Dis 18: 1191–1210.
-
18.
Norman DC , 2000. Fever in the elderly. Clin Infect Dis 31: 148–151.
-
19.
World Health Organization , 2018. Global Health Estimates 2016: Deaths by Cause, Age, Sex, by Country and by Region, 2000–2016. Geneva, Switzerland: WHO.
-
20.
Tesfaw LM, 2020. Assessment of the association between fever, diarrhea, and cough of children under-five in Ethiopia using log-linear model. Turkiye Klinikleri J Biostat 12: 272–279.
-
21.
Walker CLF, Perin J, Katz J, Tielsch JM, Black RE , 2013. Diarrhea as a risk factor for acute lower respiratory tract infections among young children in low income settings. J Glob Health 3: 010402.
-
22.
Loevinsohn GS , 2020. Acute Respiratory Infections in Rural Zambia: Viruses and Disease Patterns. Baltimore, MD: Johns Hopkins University Press.
-
23.
Perry S, de la Luz Sanchez M, Hurst PK, Parsonnet J , 2005. Household transmission of gastroenteritis. Emerg Infect Dis 11: 1093–1096.
-
24.
Longini IM Jr, Koopman JS, Monto AS, Fox JP , 1982. Estimating household and community transmission parameters for influenza. Am J Epidemiol 115: 736–751.
-
25.
Ujiie M, Izumi S, Takeshit N, Takasaki J, Mizuno Y, Kato Y, Kanagaw S, Kudo K , 2010. Household transmission of pneumococcal pneumonia associated with pandemic influenza (H1N1) 2009. Nihon Kokyuki Gakkai Zasshi 48: 322–327.
-
26.
Deutsch-Feldman M et al., 2018. Efficiency of a malaria reactive test-and-treat program in southern Zambia: a prospective, observational study. Am J Trop Med Hyg 98: 1382–1388.
-
27.
Dougherty L, Gilroy K, Olayemi A, Ogesanmola O, Ogaga F, Nweze C, Banerjee J, Oduenyi C, Pacqué M , 2020. Understanding factors influencing care seeking for sick children in Ebonyi and Kogi states, Nigeria. BMC Public Health 20: 746.
-
28.
Abuzerr S, Nasseri S, Yunesian M, Hadi M, Mahvi AH, Nabiza- deh R, Mustafa AA, 2019. Prevalence of diarrheal illness and healthcare-seeking behavior by age-group and sex among the population of Gaza strip: a community-based cross-sectional study. BMC Public Health 19: 1–8.
.png)
The Unmeasured Burden of Febrile, Respiratory, and Diarrheal Illnesses Identified Through Active Household Surveillance in a Low Malaria Transmission Setting in Southern Zambia
ABSTRACT.
Malaria incidence has declined in southern Zambia over recent decades, leading to efforts to achieve and sustain malaria elimination. Understanding the remaining disease burden is key to providing optimal health care. A longitudinal study conducted in a rural area of Choma District, Southern Province, Zambia, assessed the prevalence of and factors associated with symptoms of non-malarial illnesses and treatment-seeking behavior. We analyzed data collected monthly between October 2018 through September 2020 from 1,174 individuals from 189 households. No incident malaria cases were detected by rapid diagnostic tests among febrile participants. Mixed-effects logistic regression identified factors associated with cough, fever, diarrhea, and treatment-seeking. Incidence rates of cough (192 of 1,000 person-months), fever (87 of 1,000 person-months), and fever with cough (37 of 1,000 person-months) were highest among adults older than 65 years. Diarrhea incidence (37 of 1,000 person-months) was highest among children younger than 5 years. For every additional symptomatic household member, one’s odds of experiencing symptoms increased: cough by 47% (95% CI, 40–55), fever by 31% (95% CI, 23–40), diarrhea by 31% (95% CI, 17–46), and fever with cough by 112% (95% CI, 90–137), consistent with household clustering of illnesses. However, between 35% and 75% of participants did not seek treatment for their symptoms. Treatment-seeking was most common for children 5 to 9 years old experiencing diarrhea (adjusted odds ratio, 3.61; 95% CI, 1.42–9.18). As malaria prevalence reduces, respiratory and diarrheal infections persist, particularly among young children but, notably, also among adults older than 65 years. Increasing awareness of the disease burden and treatment-seeking behavior are important for guiding resource re-allocation as malaria prevalence declines in this region.
- Supplemental Materials (PDF 33 KB)
Author Notes
Financial support: This work was supported by the Johns Hopkins Malaria Research Institute, the Bloomberg Philanthropies, the Division of Microbiology and Infectious Diseases, National Institutes of Allergies and Infectious Diseases, NIH as part of the International Centers of Excellence for Malaria Research (U19 AI089680), and a Global Health Established Field Placement award to A. K. M. from the Johns Hopkins University Centers for Global Health.
Authors’ addresses: Alexandra K. Mueller, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, E-mail: alexandra@jhmi.edu. Japhet Matoba, Harry Hamapumbu, Jennifer C. Stevenson, and Philip E. Thuma, Macha Research Trust, Choma District, Zambia, E-mails: japhet.matoba@macharesearch.org, harry.hamapumbu@macharesearch.org, jennycstevenson80@gmail.com, and phil.thuma@macharesearch.org. Jessica L. Schue, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, E-mail: jlschue@jhu.edu. Tamaki Kobayashi and Amy Wesolowski, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, E-mails: tkobaya2@jhu.edu and awesolowski@jhu.edu. William J. Moss, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, and W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, E-mail: wmoss1@jhu.edu.