Spatial distribution of incident pediatric Burkitt lymphoma in central and northern Malawi and association with malaria prevalence

Abstract

Background: Burkitt lymphoma (BL) accounts for 90% of pediatric lymphomas in sub-Saharan Africa. Plasmodium falciparum malaria is considered an etiological factor of BL.We describe the geographic distribution of pediatric BL in Malawi and association with P. falciparum malaria prevalence rate (PfPR). Methods: We enrolled 220 pathologically confirmed incident pediatric BL cases (2013-2018) into an observational clinical cohort at Kamuzu Central Hospital (KCH) in Lilongwe district. KCH is the main tertiary cancer referral center serving the central and northern regions of Malawi. Using an ecological study design, we calculated district-level annual BL incidence rate using census population estimates. District-level PfPR was extracted from the National Malaria Control Program 2010 report. BL incidence and PfPR maps were constructed in QGIS. Moran's I test was used to identify BL spatial clusters. Pearson's correlation and multiple linear regression analyses were used to statistically examine the relationship between PfPR and BL.Results: BL incidence was higher in central region districts (8.2 cases per million) than northern districts (2.9 cases per million) and was elevated in lakeshore districts. Districts with elevated PfPR tended to have elevated BL incidence. A low-risk BL cluster was detected in the north. Statistically, BL incidence was positively correlated with PfPR (r = .77, p < .01). A 1% increase in PfPR predicted an increase in BL incidence of 0.2 cases per million (p = .03), when controlling for travel time from referral district hospital to KCH. Conclusion:Our study supports evidence for an association between P. falciparum and BL and highlights a need to improve geographic accessibility to tertiary cancer services in Malawi's northern region.

Mosquito Bed Net Use and Burkitt Lymphoma Incidence in Sub-Saharan Africa

“…After screening and deduplication of the 2 sets of data sources, a total of 13 publications from literature databases and 10 IARC reports were included . One article reported BL incidence in individuals aged 0 to 19 years while otherwise meeting inclusion criteria, but unpublished data in the group aged 0 to 15 years could not be obtained on request …”

“…1,5,27,[32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51] One article reported BL incidence in individuals aged 0 to 19 years while otherwise meeting inclusion criteria, but unpublished data in the group aged 0 to 15 years could not be obtained on request. 4 A total of 76 location-and time-specific BL incidence rates based on a total of 5700 cases were extracted from the 23 publications 1,5,27,32-51 (eTable 2 in Supplement 1).…”

“…1,2 Malaria still poses an important public health problem, with over 200 million clinical cases worldwide annually. 3 Malaria parasite prevalence and the cumulative number of infections correlate with BL incidence at the population level, 4,5 and individual-level associations between malaria infection or antimalarial antibody titers and BL risk have been reported. 6 This combined evidence raises the possibility that interventions against malaria might have downstream beneficial effects on reducing the burden of BL.…”

Association between insecticide-treated bed net use and Burkitt lymphoma incidence in children in sub-Saharan Africa: a systematic review and population-level analysis

“…Screening was performed independently by two reviewers blinded to each other’s decision, and disagreements were resolved through discussion. One article reported BL incidence in 0-19 year while otherwise meeting inclusion criteria, but unpublished data in the 0-15 year group could not be obtained on request (4). Data was extracted independently by the two reviewers into a pre-validated Microsoft Office Excel template, with any differences resolved in a final assessment.…”

“…Malaria still poses an important public health problem, with over 200 million clinical cases annually (3). Malaria parasite prevalence and the cumulative number of infections correlate with BL incidence on the population level (4, 5), and individual-level associations between malaria infection or anti-malarial antibody titres and BL risk have been reported (6).…”