Gender difference in the incidence of malaria diagnosed at public health facilities in Uganda

Abstract

Background Routine malaria surveillance data in Africa primarily come from public health facilities reporting to national health management information systems. Although information on gender is routinely collected from patients presenting to these health facilities, stratification of malaria surveillance data by gender is rarely done. This study evaluated gender difference among patients diagnosed with parasitological confirmed malaria at public health facilities in Uganda. Methods This study utilized individual level patient data collected from January 2020 through April 2021 at 12 public health facilities in Uganda and cross-sectional surveys conducted in target areas around these facilities in April 2021. Associations between gender and the incidence of malaria and non-malarial visits captured at the health facilities from patients residing within the target areas were estimated using poisson regression models controlling for seasonality. Associations between gender and data on health-seeking behaviour from the cross-sectional surveys were estimated using poisson regression models controlling for seasonality. Results Overall, incidence of malaria diagnosed per 1000 person years was 735 among females and 449 among males (IRR = 1.72, 95% CI 1.68–1.77, p < 0.001), with larger differences among those 15–39 years (IRR = 2.46, 95% CI 2.34–2.58, p < 0.001) and over 39 years (IRR = 2.26, 95% CI 2.05–2.50, p < 0.001) compared to those under 15 years (IRR = 1.46, 95% CI 1.41–1.50, p < 0.001). Female gender was also associated with a higher incidence of visits where malaria was not suspected (IRR = 1.77, 95% CI 1.71–1.83, p < 0.001), with a similar pattern across age strata. These associations were consistent across the 12 individual health centres. From the cross-sectional surveys, females were more likely than males to report fever in the past 2 weeks and seek care at the local health centre (7.5% vs. 4.7%, p = 0.001) with these associations significant for those 15–39 years (RR = 2.49, 95% CI 1.17–5.31, p = 0.018) and over 39 years (RR = 2.56, 95% CI 1.00–6.54, p = 0.049). Conclusions Females disproportionately contribute to the burden of malaria diagnosed at public health facilities in Uganda, especially once they reach childbearing age. Contributing factors included more frequent visits to these facilities independent of malaria and a higher reported risk of seeking care at these facilities for febrile illnesses.

Automated measurement of malaria parasitaemia among asymptomatic blood donors in Malawi using the Sysmex XN-31 analyser: could such data be used to complement national malaria surveillance in real time?

“…Parasitaemia rates were significantly (p < 0.001) and consistently higher in male donors (13.1%) compared with female donors (7.4%), irrespective of location or month of collection. This male bias of parasitologically confirmed malaria infection prevalence is in keeping with several other studies conducted in Africa [ 24 , 27 , 29 , 30 ]. Interestingly, different temporal trends for male and female donor malaria prevalence were observed, with males mirroring the generally reported seasonal increase from November to April and female donors having a more stable malaria prevalence over time (Fig.…”

Malaria outbreak facilitated by increased mosquito breeding sites near houses and cessation of indoor residual spraying, Kole district, Uganda, January-June 2019

“…This disproportionate burden has been widely reported both in Uganda and globally [ 4 , 8 , 16 , 20 ]. In addition, females were twice as affected as males., a finding reported previously in multiple districts of Uganda [ 21 ]. Females in Kole District might engage in activities that increase their exposure to mosquitoes.…”

“…During our study, we observed that cooking areas were outside the house, meaning that women would likely be exposed in the evenings while preparing meals. It should be noted that in comparison to males, females are also more likely to report fevers to health facilities and have more opportunities to be tested for malaria during child health care or antenatal visits [ 21 ]. However, pregnancy may also increase susceptibility [ 22 ].…”

Multilevel Modelling of Individual, Community and Regional Level Factors Associated with Insecticide-Treated Net Usage among Pregnant Women in Ethiopia

“…In areas with high prevalence, the most vulnerable groups are young children, who have not yet developed immunity to malaria, and pregnant women, whose immunity has been decreased due to pregnancy [ 3 ]. In low-prevalence areas, the women generally have developed no immunity to malaria [ 4 ]. Malaria infection is the major cause of maternal anemia, premature delivery, and fetal loss [ 3 , 4 ].…”

“…In low-prevalence areas, the women generally have developed no immunity to malaria [ 4 ]. Malaria infection is the major cause of maternal anemia, premature delivery, and fetal loss [ 3 , 4 ]. For equal exposure, adult men and women are equally vulnerable to malaria infection, but pregnant women are at greater risk of malaria infection [ 4 , 5 ].…”