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Malaria infection and severe disease risks in Africa

Robert S Paton1, Alice Kamau2,3, Samuel Akech4

  • 1Department of Zoology, University of Oxford, Oxford, UK. robert.paton@zoo.ox.ac.uk akamau@kemri-wellcome.org.

Science (New York, N.Y.)
|August 20, 2021
PubMed

Insights

Higher Plasmodium falciparum prevalence doubles severe malaria admissions in East African children. Young children aged 3-59 months bear the brunt of severe malaria across diverse community parasite infection levels.

Area of Science:

  • Global Health
  • Infectious Diseases
  • Epidemiology

Background:

  • The link between Plasmodium falciparum (malaria) community prevalence and severe disease burden is not well understood.
  • Severe malaria poses a significant threat, particularly to young children in endemic regions.

Purpose of the Study:

  • To quantify the association between community malaria parasite prevalence and severe malaria phenotypes in East African children.
  • To analyze the burden of severe malaria across a spectrum of Plasmodium falciparum infection levels.

Main Methods:

  • A dataset of 6506 pediatric malaria hospital admissions (3 months to 9 years) from 2006-2020 in East Africa was compiled.
  • Admission data were linked with community Plasmodium falciparum infection prevalence surveys.
  • A Bayesian statistical approach was employed to model exposure-outcome relationships, accounting for uncertainties.

Main Results:

  • A 25% increase in community Plasmodium falciparum prevalence was associated with a twofold increase in severe malaria admission rates.
  • Severe malaria admissions predominantly affected children aged 3 to 59 months.
  • The findings held true across a wide range of typical East African community prevalence levels.

Conclusions:

  • Community parasite prevalence is a strong predictor of severe malaria hospitalizations in children.
  • Young children (3-59 months) are disproportionately affected by severe malaria, irrespective of prevalence.
  • This study provides a quantitative framework to link malaria transmission intensity with severe disease outcomes.

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