Plasmodium falciparum malaria parasitaemia among indigenous Batwa and non-indigenous communities of Kanungu district, Uganda

Abstract

BackgroundThe indigenous Batwa of southwestern Uganda are among the most highly impoverished populations in Uganda, yet there is negligible research on the prevalence of malaria in this population. Plasmodium falciparum malaria parasitaemia prevalence was estimated in an indigenous Batwa and a non-indigenous neighbouring population, and an exploration of modifiable risk factors was carried out to identify potential entry points for intervention. Additionally, evidence of zooprophylaxis was assessed, hypothesizing that livestock ownership may play a role in malaria risk.MethodsTwo cross-sectional surveys of Batwa and non-Batwa communities were carried out in Kanungu District, Uganda in July 2013 and April 2014 based on a census of adult Batwa and a two-stage systematic random sample of adult non-Batwa in ten Local Councils where Batwa settlements are located. A community-based questionnaire and antigen rapid diagnostic test for P. falciparum were carried out in the cross-sectional health surveys. A multivariable logistic regression model was built to identify risk factors associated with positive malaria diagnostic test. A subset analysis of livestock owners tested for zooprophylaxis.ResultsBatwa experienced higher prevalence of malaria parasitaemia than non-Batwa (9.35 versus 4.45 %, respectively) with over twice the odds of infection (OR 2.21, 95 % CI 1.23–3.98). Extreme poverty (OR 1.96, 95 % CI 0.98–3.94) and having an iron sheet roof (OR 2.54, 95 % CI 0.96–6.72) increased the odds of infection in both Batwa and non-Batwa. Controlling for ethnicity, wealth, and bed net ownership, keeping animals inside the home at night decreased the odds of parasitaemia among livestock owners (OR 0.29, 95 % CI 0.09–0.94).ConclusionA health disparity exists between indigenous Batwa and non-indigenous community members with Batwa having higher prevalence of malaria relative to non-Batwa. Poverty was associated with increased odds of malaria infection for both groups. Findings suggest that open eaves and gaps in housing materials associated with iron sheet roofing represent a modifiable risk factor for malaria, and may facilitate mosquito house entry; larger sample sizes will be required to confirm this finding. Evidence for possible zooprophylaxis was observed among livestock owners in this population for those who sheltered animals inside the home at night.

Community perceptions of mental illness in rural Uganda: An analysis of existing challenges facing the Bwindi Mental Health Programme

“…The district has an estimated population of 252 100. 13 The Kanungu district is remote with limited infrastructure and service delivery. 13 , 14 Eighty per cent of the population lives in rural settlements.…”

“… 13 The Kanungu district is remote with limited infrastructure and service delivery. 13 , 14 Eighty per cent of the population lives in rural settlements. 15 The majority of the people are of Bakiga ethnicity, while the remainder (~900 individuals) are the indigenous Batwa population who were displaced with the 1993 Bwindi National Park designation.…”

Pre-clinical evaluation of CYP 2D6 dependent drug–drug interactions between primaquine and SSRI/SNRI antidepressants

“…Despite the importance of primaquine in malaria treatment efforts, the mechanism of primaquine efficacy and haemolytic toxicity are not completely understood [ 4 ]. Recently, a series of studies indicated that primaquine is a pro-drug that is converted to an active metabolite(s) via hepatic metabolism [ 5 – 13 ]. CYP 2D6 and MAO-A are the key enzymes associated with primaquine metabolism, however, primaquine’s anti-malarial activity is dependent on CYP 2D6-mediated activation [ 6 , 7 , 12 , 14 , 15 ].…”

Examination of Antibody Responses as a Measure of Exposure to Malaria in the Indigenous Batwa and Their Non-Indigenous Neighbors in Southwestern Uganda

“…Community-based cross-sectional surveys were conducted as described in detail elsewhere. 13,14 In April 2014, 136 indigenous Batwa households and 201 non-indigenous Bakiga households were surveyed in the 10 local councils (hereafter referred to as "cells") in Kanungu District, comprising all of Kanungu's 10 Batwa settlements and their neighboring Bakiga villages, resulting in a total of 543 and 731 individuals, respectively. The response rate was 94.9% and 99.4% among the Batwa and Bakiga, respectively.…”