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Volume 12, Number 10—October 2006
Perspective

Malaria Epidemics and Interventions, Kenya, Burundi, Southern Sudan, and Ethiopia, 1999–2004

Francesco Checchi*†Comments to Author , Jonathan Cox†, Suna Balkan‡, Abiy Tamrat§, Gerardo Priotto*, Kathryn P. Alberti*, Dejan Zurovac‡¶#, and Jean-Paul Guthmann*
Author affiliations: *Epicentre, Paris, France; †London School of Hygiene and Tropical Medicine, London, United Kingdom; ‡Médecins Sans Frontières, Paris, France; §Médecins Sans Frontières, Geneva, Switzerland; ¶Kenya Medical Research Institute/Wellcome Trust Research Laboratories, Nairobi, Kenya; #University of Oxford, Oxford, United Kingdom

Main Article

Table 1

Characteristics of intervention sites and potential determinants of epidemics*

Characteristic/ determinant Kisii/Gucha, Kenya Kayanza, Burundi Aweil East, southern Sudan Gutten, Ethiopia Damot Gale, Ethiopia
Epidemic period (no. weeks) May–August 1999 (15) September 2000–May 2001 (36) June–November 2003 (22) July 2003–February 2004 (33) July 2003–January 2004 (30)
Population 956,000 578,000 307,000 44,000 287,000
Altitude (m) 1,200–2,200 1,400–1,750 430 1,700 1,600–2,100
Malaria vectors Anopheles funestus (constant), A. gambiae sensu lato (seasonal) A. arabiensis (95%), A. funestus (5%) Not available (A. gambiae sensu lato presumed) A. arabiensis A. arabiensis
Malaria species (nonepidemic months) Plasmodium falciparum (>90%) P. falciparum (>90%) P. falciparum (>95%) P. falciparum (≈25%), P. vivax (≈75%) P. falciparum (≈60%), P. vivax (≈40%)
Temperature anomalies Above average in 3 preepidemic months None apparent Maximum LST strongly below average during epidemic None apparent None apparent
Rainfall anomalies Heavy rainfall in preepidemic rainy season after drought in previous rainy season Heavy rainfall 5 and 3 months before epidemic, drought 2 years before epidemic but not in preepidemic year Below average rainfall in 3 preepidemic years, above average in 2 preepidemic months Below average rainfall in 2 preepidemic and epidemic years but heavy rainfall in preepidemic month Below average rainfall in 2 preepidemic and epidemic years but heavy rainfall in 3 preepidemic months
Land pattern changes None reported Creation of rice paddies and fish ponds Widespread flooding Creation of water ponds None reported
Political instability None Armed conflict Tenuous ceasefire Inactive insurgency Inactive insurgency
Population movement None Forced relocation Seminomadic, returnees from north Sudan Government resettlement schemes Government resettlement schemes
Global acute malnutrition† Not available 10%–15% 25% Not available (probably >5%) 28%
Drug resistance (in vivo failure rates) CQ 24%–87% (neighboring districts), SP 10% (13) CQ 100%, SP 54.2%, CQ+SP 42.0% (9) CQ 63%, SP 3% (14)‡ SP 78.0% (15) SP 68.1% (neighboring zone) (15)

*LST, land surface temperature; CQ, chloroquine; SP, sulfadoxine-pyrimethamine.
†Among children <5 y of age; malnutrition rates >15% denote a serious situation; values are provided for 2 months before the epidemic.
‡Percentages refer to the frequency of single Pfcrt mutations and triple Dhfr mutations in the P. falciparum genome of outpatients sampled in Aweil East. These mutations are predictive of in vivo CQ and SP failure rates, respectively.

Main Article

References
  1. World Health Organization/UNICEF. The Africa malaria report 2003. Geneva: WHO/Roll Back Malaria; 2003. Available from http://www.unicef.org/publications/index_7936.html
  2. Worrall  E, Rietveld  A, Delacollette  C. The burden of malaria epidemics and cost-effectiveness of interventions in epidemic situations in Africa. Am J Trop Med Hyg. 2004;71(Suppl):136–40.PubMedGoogle Scholar
  3. Abeku  TA, de Vlas  SJ, Borsboom  GJ, Tadege  A, Gebreyesus  Y, Gebreyohannes  H, Effects of meteorological factors on epidemic malaria in Ethiopia: a statistical modelling approach based on theoretical reasoning. Parasitology. 2004;128:585–93. DOIPubMedGoogle Scholar
  4. Hay  S, Renshaw  M, Ochola  SA, Noor  AM, Snow  RW. Performance of forecasting, warning and detection of malaria epidemics in the highlands of western Kenya. Trends Parasitol. 2003;19:394–9. DOIPubMedGoogle Scholar
  5. Zhou  G, Minakawa  N, Githeko  AK, Yan  G. Climate variability and malaria epidemics in the highlands of East Africa. Trends Parasitol. 2005;21:54–6. DOIPubMedGoogle Scholar
  6. Kovats  RS, Bouma  MJ, Hajat  S, Worrall  E, Haines  A. El Niño and health. Lancet. 2003;362:1481–9. DOIPubMedGoogle Scholar
  7. Abeku  TA, Hay  SI, Ochola  S, Langi  P, Beard  B, de Vlas  SJ, Malaria epidemic early warning and detection in African highlands. Trends Parasitol. 2004;20:400–5. DOIPubMedGoogle Scholar
  8. Vong  S. Malaria outbreak in Kisii and Gucha districts, Nyanza Province, Kenya: descriptive epidemiology and estimation of the prevalence of malaria parasites in the general population of the two districts. Paris: Epicentre; 1999.
  9. Legros  D. Epidemie de paludisme du Burundi: Septembre 2000–Mai 2001. Paris: Epicentre; 2001.
  10. Checchi  F. Responding to a seasonal malaria emergency: experience from Bahr el Ghazal, southern Sudan. Paris: Epicentre; 2004.
  11. Priotto  G. Malaria epidemic surveillance in East Wellega, Ethiopia. Paris: Epicentre; 2003.
  12. Alberti  K. A malaria assessment in Damot Gale woreda, Wolayita Zone, Ethiopia. Paris: Epicentre; 2003.
  13. Snow  RW, Ikoku  A, Omumbo  J, Ouma  J. The epidemiology, politics and control of malaria epidemics in Kenya: 1900–1998. Nairobi: World Health Organization; 1999. Available from http://www.who.int/malaria/docs/ek_report_toc1.htm
  14. Anderson  TJ, Nair  S, Jacobzone  C, Zavai  A, Balkan  S. Molecular assessment of drug resistance in Plasmodium falciparum from Bahr El Gazal province, Sudan. Trop Med Int Health. 2003;8:1068–73. DOIPubMedGoogle Scholar
  15. Jima  D, Tesfaye  G, Medhin  A, Kebede  A, Argaw  D, Babaniyi  O. Efficacy of sulfadoxine-pyrimethamine for the treatment of uncomplicated falciparum malaria in Ethiopia. East Afr Med J. 2005;82:391–5.PubMedGoogle Scholar
  16. Hay  SI, Simba  M, Busolo  M, Noor  AM, Guyatt  HL, Ochola  SA, Defining and detecting malaria epidemics in the highlands of western Kenya. Emerg Infect Dis. 2002;8:555–62.PubMedGoogle Scholar
  17. Zhou  G, Minakawa  N, Githeko  AK, Yan  G. Association between climate variability and malaria epidemics in the East African highlands. Proc Natl Acad Sci U S A. 2004;101:2375–80. DOIPubMedGoogle Scholar
  18. Ministere de la Santè Publique. Plan strategique faire reculer le paludisme au Burundi, 2003–2007. Bujumbura (Burundi): Ministere de la Sante Publique; 2002.
  19. Negash  K, Kebede  A, Medhin  A, Argaw  D, Babaniyi  O, Guintran  JO, Malaria epidemics in the highlands of Ethiopia. East Afr Med J. 2005;82:186–92.PubMedGoogle Scholar
  20. The Sphere Project. Sphere handbook. 2004 [cited 2006 Jul 18]. Available from http://www.sphereproject.org/content/view/27/84/lang,English/
  21. Hay  SI, Lennon  JJ. Deriving meteorological variables across Africa for the study and control of vector-borne disease: a comparison of remote sensing and spatial interpolation of climate. Trop Med Int Health. 1999;4:58–71. DOIPubMedGoogle Scholar
  22. Grover-Kopec  E, Kawano  M, Klaver  RW, Blumenthal  B, Ceccato  P, Connor  SJ. An online operational rainfall-monitoring resource for epidemic malaria early warning systems in Africa. Malar J. 2005;4:6. DOIPubMedGoogle Scholar
  23. Myers  MF, Rogers  DJ, Cox  J, Flahault  A, Hay  SI. Forecasting disease risk for increased epidemic preparedness in public health. Adv Parasitol. 2000;47:309–30. DOIPubMedGoogle Scholar
  24. World Health Organization. Malaria epidemics: forecasting, prevention, early detection and control—from policy to practice. Geneva: The Organization; 2004. Available from http://www.who.int/malaria/docs/Leysinreport.pdf
  25. Williams  HA, Jones  CO. A critical review of behavioral issues related to malaria control in sub-Saharan Africa: what contributions have social scientists made? Soc Sci Med. 2004;59:501–23. DOIPubMedGoogle Scholar
  26. Reyburn  H, Mbatia  R, Drakeley  C, Bruce  J, Carneiro  I, Olomi  R, Association of transmission intensity and age with clinical manifestations and case fatality of severe Plasmodium falciparum malaria. JAMA. 2005;293:1461–70. DOIPubMedGoogle Scholar
  27. Bousema  JT, Gouagna  LC, Meutstege  AM, Okech  BE, Akim  NI, Githure  JI, Treatment failure of pyrimethamine-sulphadoxine and induction of Plasmodium falciparum gametocytaemia in children in western Kenya. Trop Med Int Health. 2003;8:427–30. DOIPubMedGoogle Scholar
  28. Hay  SI, Noor  AM, Simba  M, Busolo  M, Guyatt  HL, Ochola  SA, Clinical epidemiology of malaria in the highlands of western Kenya. Emerg Infect Dis. 2002;8:543–8.PubMedGoogle Scholar
  29. World Health Organization. Malaria epidemics—detection and control, forecasting and prevention. Geneva: The Organization; 1998. Available from http://www.who.int/malaria/docs/najera_epidemics/naj_toc.htm

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