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MALARIA MORBIDITY AMONG SCHOOL CHILDREN LIVING IN TWO AREAS OF CONTRASTING TRANSMISSION IN WESTERN KENYA

Research in malaria-endemic areas is usually focused on malaria during early childhood. Less is known about malaria among older school age children. The incidence of clinical attacks of malaria was monitored, using active case detection in primary schools, in two areas of western Kenya that differ in the intensity of transmission. Clinical malaria was more common in schools in the Nandi highlands, with a six-fold higher incidence of malaria attacks during the malaria epidemic in 2002, compared with school children living in a holoendemic area with intense perennial transmission during the same period. The high incidence coupled with the high parasite densities among cases is compatible with a low level of protective immunity in the highlands. The malaria incidence among school children exposed to intense year-round transmission (26 per 100 school children per year) was consistent with reports from other holoendemic areas. Taken together with other published studies, the data suggest that malaria morbidity among school age children increases as transmission intensity decreases. The implications for malaria control are discussed.

Received February 14, 2004. Accepted for publication July 7, 2004.

Acknowledgments: We are very grateful to the children and teachers of the schools in Kapkangani and Bondo who kindly participated in the study. We are also most appreciative of those who were responsible for carrying out the active and passive case detection, which made this analysis possible, and the fieldworkers who contributed towards data collection. We are grateful for the excellent work of the late Benbolt Mugo. We also thank Larry Barat, Tarekegn Abeku, and Brian Greenwood for their contributions and suggestions.

Financial support: This work was supported by the Danish Bilharziasis Laboratory, the World Bank, the Bill and Melinda Gates Foundation (through an award to the Gates Malaria Partnership, London School of Hygiene and Tropical Medicine), and the Wellcome Trust (through a Prize Fellowship [062692] to Simon Brooker at the time of the study).

Authors’ addresses: Siân E. Clarke and Simon Brooker, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom, E-mails: sian.clarke{at}lshtm.ac.uk and simon.brooker{at}lshtm.ac.uk. Joseph Kiambo Njagi, Division of Malaria Control, and Division of Vector Borne Disease, Ministry of Health, Nairobi, Kenya, E-mail: eanmat{at}africaonline.co.ke. Eliud Njau and Eric Muchiri, Division of Vector Borne Disease, Ministry of Health, Nairobi, Kenya, E-mail: dvbd{at}wanachi.co.ke. Benson Estambale, Kenyatta National Hospital, PO Box 20723, Nairobi, Kenya, E-mail: bestambale{at}uonbi.ac.ke. Pascal Magnussen, Danish Bilharziasis Laboratory, Charlottenlund, Denmark, E-mail: pm{at}bilharziasis.dk.

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