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Declining incidence of malaria in a cohort of children living in Kampala, Uganda

Source: TropIKA

There have been reports of declining malaria incidence in Africa. What factors are responsible for this?

Author: Paul Chinnock

In the last few years there have been reports from several parts of Africa of a decrease in the number of cases of malaria. Wonderful news, but why is this happening? Is it because of the introduction of new malaria control interventions – such as artemisinin combination therapies (ACTs) and insecticide-treated bednets (ITNs) ­– or are so-far unidentified factors partly responsible?

The issue will be discussed by Denise Njama-Meya of the Makerere University-University of Carlifornia San Francisco Research Collaboration. Her presentation will include data from a cohort of children who were originally recruited in 2004 as participants in a trial (1) comparing the efficacy and safety of three ACTs for the treatment of uncomplicated malaria. These children, and others recruited in a second enrolment in 2007, provide yet another example of declining incidence rates in Africa.

In a brief interview with TropIKA.net, Njama-Meya said the reductions found in this cohort of children, from Uganda’s capital, Kampala, were real and were not the result of changes in diagnostic procedures.

She described the encouraging progress made with the introduction of new malaria interventions in the Kampala area. Treatment with the ACT Coartem is now widely given and the use of ITNs has increased considerably since a distribution programme in 2006; promotion campaigns involving regular house visits had raised usage levels from around 50% to approaching 100%.

There will be no data from rural of Uganda in Njama-Meya’s presentation, though she said that routine reports from these areas also suggested there has been a decline in malaria case numbers, which has generally been attributed to the expansion of home-based case management.

Nevertheless, in her presentation, she will be emphasising that the reduction in incidence is unlikely to be explained entirely by these new interventions: “There may be something else going on and we need to find out what it is”. Her project, however, is not in a position to investigate whether, for example, environmental factors such as climate or socioeconomic factors have played a role. She raises the possibility that the introduction of sulfadoxine-pyrimethamine (SP) treatment for malaria played a part in starting a downward trend in incidence, even though SP drug resistance has subsequently become a problem.

Denise Njama-Meya is pleased to be attending MIM 2009. Once every three years, she says, the event brings African scientists together and allows them to share ideas that will lead to reductions in malaria morbidity and mortality. She is looking forward to meeting researchers with whom she is already collaborating and others who are involved in similar work.

Reference

1. Dorsey G, Staedke S, Clark TD, Njama-Meya D, Nzarubara B, Maiteki-Sebuguzi C, Dokomajilar C, Kamya MR, Rosenthal PJ (2007). Combination therapy for uncomplicated falciparum malaria in Ugandan children: a randomized trial. JAMA; 297(20):2210-2219.

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