Related Experiment Videos
[Relationship between Plasmodium parasitemia and febrile episodes in various population groups in Kinshasa, Zaire]
P M Mulumba1, M Wéry, N N Ngimbi
1Service de Parasitologie, Faculté de Médecine, UNIKIN, Kinshasa XI, Zaïre.
Insights
High malaria parasite density in children is the primary cause of fever episodes in Kinshasa. Environmental factors and socio-economic status also significantly influence fever risk.
Area of Science:
- Tropical medicine
- Epidemiology
- Public health
Context:
- Kinshasa experiences perennial malaria transmission, necessitating an understanding of fever determinants.
- Urbanization levels vary across Kinshasa's neighborhoods, potentially impacting disease transmission dynamics.
Purpose:
- To identify and rank the key factors contributing to fever episodes in children under 10 in Kinshasa.
- To analyze the relationship between malaria parasitemia, environmental factors, and fever incidence.
Summary:
- A study in Kinshasa followed 4,816 children, recording 906 fever episodes. High malaria parasite density (over 3,000 trophozoites/microliter) was strongly associated with fever, increasing risk 40-fold compared to negative tests.
- Environmental factors, including neighborhood urbanization and socio-economic status, were significant independent determinants of fever risk.
- Younger age and shorter dry seasons also contributed to fever episodes, highlighting a multifactorial etiology.
Impact:
- Findings emphasize the critical role of malaria parasite density in causing fever, guiding targeted interventions.
- Highlights the influence of habitat and socio-economic factors, informing public health strategies for malaria control in urban and semi-urban settings.
- Provides crucial data for developing effective fever management protocols and malaria prevention programs in high-transmission areas.
Abstract:
The objective of this study was to determine the relative importance of determinants of fever-episodes in an environment with perennial malaria transmission. In 6 neighbourhoods of Kinshasa with different degrees of urbanization, 120 clusters of children younger than 10 years were selected over a one year period and followed up for 2 weeks each. In the 4,816 children retained for analysis 906 fever episodes were registered, which corresponds to an average incidence rate of 4.9 episodes per child per year. Seven hundred (77.3%) of the fever cases had a positive thick film (IF) but of the 3,289 children with a positive TF only 21.3% presented fever during the observation period. Nevertheless, high parasite densities formed, without neglecting the role of other infectious etiologies, the mayor pathogenic mechanism associated with fever. The risk for a fever episode was, in multivariate analysis, 40 times higher in children with at least one positive TF than in children with a negative TF on both day 1 and day 14, and amongst the ones with a positive TF the risk was 3 times higher in children with a parasitemia above 3,000 trophozoites/microliter blood. The habitat constituted another important independent determinant: the relative risk for fever was 1.48 for non-urbanized neighbourhoods, which probably reflects the low malaria transmission in the urbanized ones, but 2.1 for semi-urbanized against peripheral neighbourhoods, where the parasite index is high. Low socio-economic status, the short dry season and young age formed, in this order, further factors to the take into account.