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BMC Medicine
Published in: BMC Medicine 1/2019

Open Access 01-12-2019 | Malaria | Research article

Observational study: 27 years of severe malaria surveillance in Kilifi, Kenya

Authors: Patricia Njuguna, Kathryn Maitland, Amek Nyaguara, Daniel Mwanga, Polycarp Mogeni, Neema Mturi, Shebe Mohammed, Gabriel Mwambingu, Caroline Ngetsa, Kenedy Awuondo, Brett Lowe, Ifedayo Adetifa, J. Anthony G. Scott, Thomas N. Williams, Sarah Atkinson, Faith Osier, Robert W. Snow, Kevin Marsh, Benjamin Tsofa, Norbert Peshu, Mainga Hamaluba, James A. Berkley, Charles R. J. Newton, John Fondo, Anisa Omar, Philip Bejon

Published in: BMC Medicine | Issue 1/2019

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Abstract

Background

Many parts of Africa have witnessed reductions in Plasmodium falciparum transmission over the last 15 years. Since immunity to malaria is acquired more rapidly at higher transmission, the slower acquisition of immunity at lower transmission may partially offset the benefits of reductions in transmission. We examined the clinical spectrum of disease and predictors of mortality after sustained changes in transmission intensity, using data collected from 1989 to 2016.

Methods

We conducted a temporal observational analysis of 18,000 children, aged 14 days to 14 years old, who were admitted to Kilifi County Hospital, Kenya, from 1989 to 2016 with malaria. We describe the trends over time of the clinical and laboratory criteria for severe malaria and associated risk of mortality.

Results

During the time periods 1989–2003, 2004–2008, and 2009–2016, Kilifi County Hospital admitted averages of 657, 310, and 174 cases of severe malaria per year including averages of 48, 14, and 12 malaria-associated deaths per year, respectively. The median ages in years of children admitted with cerebral malaria, severe anaemia, and malaria-associated mortality were 3.0 (95% confidence interval (CI) 2.2–3.9), 1.1 (95% CI 0.9–1.4), and 1.1 (95% CI 0.3–2.2) in the year 1989, rising to 4.9 (95% CI 3.9–5.9), 3.8 (95% CI 2.5–7.1), and 5 (95% CI 3.3–6.3) in the year 2016. The ratio of children with cerebral malaria to severe anaemia rose from 1:2 before 2004 to 3:2 after 2009. Hyperparasitaemia was a risk factor for death after 2009 but not in earlier time periods.

Conclusion

Despite the evidence of slower acquisition of immunity, continued reductions in the numbers of cases of severe malaria resulted in lower overall mortality. Our temporal data are limited to a single site, albeit potentially applicable to a secular trend present in many parts of Africa.
Appendix
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Metadata
Title
Observational study: 27 years of severe malaria surveillance in Kilifi, Kenya
Authors
Patricia Njuguna
Kathryn Maitland
Amek Nyaguara
Daniel Mwanga
Polycarp Mogeni
Neema Mturi
Shebe Mohammed
Gabriel Mwambingu
Caroline Ngetsa
Kenedy Awuondo
Brett Lowe
Ifedayo Adetifa
J. Anthony G. Scott
Thomas N. Williams
Sarah Atkinson
Faith Osier
Robert W. Snow
Kevin Marsh
Benjamin Tsofa
Norbert Peshu
Mainga Hamaluba
James A. Berkley
Charles R. J. Newton
John Fondo
Anisa Omar
Philip Bejon
Publication date
01-12-2019
Publisher
BioMed Central
Keyword
Malaria
Published in
BMC Medicine / Issue 1/2019
Electronic ISSN: 1741-7015
DOI
https://doi.org/10.1186/s12916-019-1359-9

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