Human mobility and factors associated with malaria importation in Lusaka district, Zambia: a descriptive cross sectional study

Lowa, Miriam; Sitali, Lungowe; Siame, Mwiche; Musonda, Patrick

doi:10.1186/s12936-018-2554-4

Cited by 17 publications

(17 citation statements)

References 11 publications

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“…In adults, behavioural factors including travel, leisure and social activities, and occupational activities such as agriculture or night-time work may have increased the risk of exposure outside the household as compared to children. Travel has been reported as a risk factor for P. falciparum infection in East and Southern Africa [43,44] and for cases of imported malaria being older than those not imported in Southern Africa [45]. Whereas occupational hazards were not evaluated in this study, considerable occupational risk of malaria has been documented among mobile male workers in Asia [46,47] and populations involved in agriculture in Africa [48,49].…”

Section: Discussionmentioning

confidence: 82%

Rapid shifts in the age-specific burden of malaria following successful control interventions in four regions of Uganda

Kigozi

Epstein

et al. 2020

Malar J

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Background: Malaria control using long-lasting insecticidal nets (LLINs) and indoor residual spraying of insecticide (IRS) has been associated with reduced transmission throughout Africa. However, the impact of transmission reduction on the age distribution of malaria cases remains unclear. Methods: Over a 10-year period (January 2009 to July 2018), outpatient surveillance data from four health facilities in Uganda were used to estimate the impact of control interventions on temporal changes in the age distribution of malaria cases using multinomial regression. Interventions included mass distribution of LLINs at all sites and IRS at two sites. Results: Overall, 896,550 patient visits were included in the study; 211,632 aged < 5 years, 171,166 aged 5-15 years and 513,752 > 15 years. Over time, the age distribution of patients not suspected of malaria and those malaria negative either declined or remained the same across all sites. In contrast, the age distribution of suspected and confirmed malaria cases increased across all four sites. In the two LLINs-only sites, the proportion of malaria cases in < 5 years decreased from 31 to 16% and 35 to 25%, respectively. In the two sites receiving LLINs plus IRS, these proportions decreased from 58 to 30% and 64 to 47%, respectively. Similarly, in the LLINs-only sites, the proportion of malaria cases > 15 years increased from 40 to 61% and 29 to 39%, respectively. In the sites receiving LLINs plus IRS, these proportions increased from 19 to 44% and 18 to 31%, respectively. Conclusions: These findings demonstrate a shift in the burden of malaria from younger to older individuals following implementation of successful control interventions, which has important implications for malaria prevention, surveillance, case management and control strategies.

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Section: Discussionmentioning

confidence: 82%

Rapid shifts in the age-specific burden of malaria following successful control interventions in four regions of Uganda

Kigozi

Epstein

et al. 2020

Malar J

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“…As such, the imported malaria prevalence in this study was lower than most surveys reviewed. The prevalence of imported malaria was higher in most studies; given the 64% in China [ 14 ], about 14 to 90% in Iran [ 33 ], 100% in South Africa [ 34 ], 53% in Swaziland [ 35 ] and 94.2% in Lusaka, Zambia [ 36 ]. However, a study conducted in Botswana showed a lower prevalence of 6.01% [ 37 ], comparable to the findings in this study.…”

Section: Discussionmentioning

confidence: 99%

“…Discussing this study conducted in a moderate malaria transmission zone, in perspective these surveys, makes it clear that imported malaria occurs in low [ 34 , 36 ], high [ 34 ] as well as moderate transmission zones, in varying proportions and without a pattern specific for particular zones. For a long time now the World Health Organization (WHO), has been recommending quantifying of the importation of infections into a region [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

Prevalence, characteristics and risk factors of imported and local malaria cases in North-Western Province, Zambia: a cross-sectional study

Chipoya

Shimaponda-Mataa

2020

Malar J

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Background Imported malaria is a major challenge for countries that are in malaria elimination stage such as Zambia. Legitimate cross-border activities add to the risk of transmission, necessitating determination of prevalence, characteristics and risk factors of imported and local malaria. Methods This cross-sectional study was conducted in 103 consented child and adult patients with clinical malaria symptoms, from selected health facilities in north-western Zambia. Patient demographic data and blood samples for malaria microscopy and full blood count were obtained. Chi-square and penalized logistic regression were performed to describe the characteristics and assess the risk factors of imported and local malaria in North-Western Province. Results Overall, malaria prevalence was 78.6% with 93.8% Plasmodium falciparum and 6.2% other species. The local cases were 72 (88.9%) while the imported were 9 (11.1%) out of the 81 positive participants. About 98.6% of the local cases were P. falciparum compared to 55.6% (χ2 = 52.4; p < 0.01) P. falciparum among the imported cases. Among the imported cases, 44% were species other than P. falciparum (χ2 = 48; p < 0.01) while among the local cases only 1.4% were. Gametocytes were present in 44% of the imported malaria cases and only in 2.8% of the local cases (χ2 = 48; p < 0.01). About 48.6% of local participants had severe anaemia compared to 33.3% of participants from the two neighbouring countries who had (χ2 = 4.9; p = 0.03). In the final model, only country of residence related positively to presence of species other than P. falciparum (OR = 39.0, CI [5.9, 445.9]; p < 0.01) and presence of gametocytes (OR = 23.1, CI [4.2, 161.6]; p < 0.01). Conclusion Malaria prevalence in North-Western Province is high, with P. falciparum as the predominant species although importation of Plasmodium ovale and Plasmodium malariae is happening as well. Country of residence of patients is a major risk factor for malaria species and gametocyte presence. The need for enhanced malaria control with specific focus on border controls to detect and treat, for specific diagnosis and treatment according to species obtaining, for further research in the role of species and gametocytaemia in imported malaria, cannot be overemphasized.

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“…Other factors that were not associated with LLIN use during travel included time to bed, gender of the participant, and age at the time of travel. Travel has been identi ed as a risk factor for malaria across Africa [11,15,19,30,31]. In Uganda, a study conducted at three sites of varied malaria transmission demonstrated that the incidence of malaria in travellers was over three times higher in the 60 days after overnight travel compared to the 60 days before travelling [16].…”

Section: Discussionmentioning

confidence: 99%

“…Travel is a well-recognised risk factor for malaria [10][11][12][13][14][15]. Studies from Uganda and elsewhere in Africa have shown that overnight travel is associated with an increased risk of malaria, especially when individuals travel from areas of lower transmission intensity to higher risk areas [16,17].…”

Section: Introductionmentioning

confidence: 99%

Association Between Recent Overnight Travel And Use Of Long-Lasting Insecticidal Nets In Rural Uganda: A Prospective Cohort Study In Tororo

Arinaitwe

Nankabirwa

Krezanoski

et al. 2020

Preprint

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Background: The burden of malaria in Uganda remains high, but has become increasingly heterogenous following intensified malaria control. Travel within Uganda is recognised as a risk factor for malaria, but behaviours associated with travel are not well-understood. To address this knowledge gap, malaria-relevant behaviours of cohort participants were assessed during travel and at home in Uganda.Methods: Residents from 80 randomly selected households in Nagongera sub-county, Tororo district were enrolled into a cohort to study malaria in rural Uganda. All participants were given long-lasting insecticidal nets (LLINs) at enrolment and were evaluated every 4 weeks at the study clinic. Participants were asked if they had travelled overnight from their home, and if so, a questionnaire was administered to capture information on travel details and behaviours. Behaviour while at home was assessed using a similar questionnaire during two-weekly home visits. Behaviours while travelling vs at home were compared using generalized estimating equations adjusting for repeated measures in the same individual. Results: Between October 2017 and October 2019, 527 participants were enrolled and assessed for travel. Of these, 123 (23.2%) reported taking 211 overnight trips; 149 (70.6%) trips were within Tororo. Participants were less likely to use LLINs when travelling than when at home (41.0% vs. 56.2%, relative risk [RR] 0.73, 95% CI: 0.60-0.89, p=0.002); this difference was noted for women (38.8% vs 59.2%, RR 0.66, 95% CI 0.52-0.83, p=0.001) but not men (48.3% vs 46.6%, RR 0.96, 95% CI 0.67-1.40, p=0.85). In an adjusted analysis, factors associated with LLIN use when travelling included destination (travelling to districts not receiving indoor residual spraying [IRS] 65.8% vs Tororo district 32.2%, RR 1.80, 95% CI 1.31-2.46, p<0.001) and duration of travel (>7 nights 60.3% vs one night 24.4%, RR 1.97, 95% CI 1.07-3.64, p=0.03).Conclusions: Travellers, particularly women, were less likely to use LLINs when travelling than when at home. LLIN adherence was higher among those who travelled to non-IRS districts and for more than one week, suggesting that perceived malaria risk influences LLIN use. Strategies are needed to raise awareness of the importance of using LLINs while travelling.

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Human mobility and factors associated with malaria importation in Lusaka district, Zambia: a descriptive cross sectional study

Cited by 17 publications

References 11 publications

Rapid shifts in the age-specific burden of malaria following successful control interventions in four regions of Uganda

Rapid shifts in the age-specific burden of malaria following successful control interventions in four regions of Uganda

Prevalence, characteristics and risk factors of imported and local malaria cases in North-Western Province, Zambia: a cross-sectional study

Association Between Recent Overnight Travel And Use Of Long-Lasting Insecticidal Nets In Rural Uganda: A Prospective Cohort Study In Tororo

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