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Current malaria interventions are failing to control the disease in high-transmission areas of sub-Saharan Africa, according to research published in The American Journal of Tropical Medicine & Hygiene.
A 2-year surveillance study revealed that the incidence of malaria in rural Uganda is high and continues to rise.
Researchers said this study offers the most accurate, comprehensive, and up-to-date measurement of the malaria disease burden in Uganda.
“Our findings suggest that current efforts at controlling malaria may not be as effective as previously believed in high-transmission areas, where the disease is the biggest threat,” said Grant Dorsey, MD, PhD, of the University of California, San Francisco.
“It’s important to tell the less happy story that we have not yet seen advances in more rural areas, including at least 2 sites in Uganda, where transmission has been historically high.”
To reach an accurate assessment of the malaria incidence in Uganda, Dr Dorsey and his colleagues gathered comprehensive surveillance data over 24 months, from August 2011 to September 2013.
Ultimately, the team evaluated 703 children between the ages of 6 months and 10 years. The children were randomly selected from 3 areas of Uganda with differing malaria characteristics.
The researchers found the incidence of malaria infection decreased in the relatively low-transmission, peri-urban Walukuba area during the study period—from an average of 0.51 to 0.31 episodes of malaria per person per year (P=0.001).
However, the incidence increased in the 2 rural areas. Episodes of malaria per person per year rose from an average of 0.97 to 1.93 (P<0.001) in the moderate-transmission area of Kihihi and rose from an average of 2.33 to 3.30 (P<0.001) in Nagongera, a high-transmission rural area near the southeastern border with Kenya.
Throughout the study period, families were provided with bednets and had access to 24-hour medical care free of charge at a designated study clinic for episodes of fever. The children were also routinely tested for malaria every 3 months, whether they had symptoms or not.
In addition, the researchers collected mosquito specimens monthly from light traps that were strategically placed in each house to estimate the percentages of malaria-carrying mosquitoes in the study areas.
Healthcare workers provided over 2500 treatments for malaria over the course of the study.
“Children in our study experienced a significantly high rate of infection, and that rate increased in the 2 rural areas,” Dr Dorsey said. “Based on prior data, our higher transmission sites are very likely to be representative of most of Uganda and perhaps of most other rural areas in sub-Saharan Africa as well.”
The researchers said these results suggest a need to further scale up campaigns to distribute insecticide-treated bednets and spray homes with insecticides. And high-transmission countries like Uganda may also require new interventions, such as using malaria drugs for prevention and controlling mosquito larvae, in order to match the malaria reduction successes seen elsewhere in the world.
In a related editorial, Steven Meshnick, MD, PhD, of the University of North Carolina, Chapel Hill, wrote, “The real take-home message of this study may be that malaria control in Africa requires sustained and consistent efforts over much more than 2 years.” 
Photo by James Gathany
Current malaria interventions are failing to control the disease in high-transmission areas of sub-Saharan Africa, according to research published in The American Journal of Tropical Medicine & Hygiene.
A 2-year surveillance study revealed that the incidence of malaria in rural Uganda is high and continues to rise.
Researchers said this study offers the most accurate, comprehensive, and up-to-date measurement of the malaria disease burden in Uganda.
“Our findings suggest that current efforts at controlling malaria may not be as effective as previously believed in high-transmission areas, where the disease is the biggest threat,” said Grant Dorsey, MD, PhD, of the University of California, San Francisco.
“It’s important to tell the less happy story that we have not yet seen advances in more rural areas, including at least 2 sites in Uganda, where transmission has been historically high.”
To reach an accurate assessment of the malaria incidence in Uganda, Dr Dorsey and his colleagues gathered comprehensive surveillance data over 24 months, from August 2011 to September 2013.
Ultimately, the team evaluated 703 children between the ages of 6 months and 10 years. The children were randomly selected from 3 areas of Uganda with differing malaria characteristics.
The researchers found the incidence of malaria infection decreased in the relatively low-transmission, peri-urban Walukuba area during the study period—from an average of 0.51 to 0.31 episodes of malaria per person per year (P=0.001).
However, the incidence increased in the 2 rural areas. Episodes of malaria per person per year rose from an average of 0.97 to 1.93 (P<0.001) in the moderate-transmission area of Kihihi and rose from an average of 2.33 to 3.30 (P<0.001) in Nagongera, a high-transmission rural area near the southeastern border with Kenya.
Throughout the study period, families were provided with bednets and had access to 24-hour medical care free of charge at a designated study clinic for episodes of fever. The children were also routinely tested for malaria every 3 months, whether they had symptoms or not.
In addition, the researchers collected mosquito specimens monthly from light traps that were strategically placed in each house to estimate the percentages of malaria-carrying mosquitoes in the study areas.
Healthcare workers provided over 2500 treatments for malaria over the course of the study.
“Children in our study experienced a significantly high rate of infection, and that rate increased in the 2 rural areas,” Dr Dorsey said. “Based on prior data, our higher transmission sites are very likely to be representative of most of Uganda and perhaps of most other rural areas in sub-Saharan Africa as well.”
The researchers said these results suggest a need to further scale up campaigns to distribute insecticide-treated bednets and spray homes with insecticides. And high-transmission countries like Uganda may also require new interventions, such as using malaria drugs for prevention and controlling mosquito larvae, in order to match the malaria reduction successes seen elsewhere in the world.
In a related editorial, Steven Meshnick, MD, PhD, of the University of North Carolina, Chapel Hill, wrote, “The real take-home message of this study may be that malaria control in Africa requires sustained and consistent efforts over much more than 2 years.”
Photo by James Gathany
Current malaria interventions are failing to control the disease in high-transmission areas of sub-Saharan Africa, according to research published in The American Journal of Tropical Medicine & Hygiene.
A 2-year surveillance study revealed that the incidence of malaria in rural Uganda is high and continues to rise.
Researchers said this study offers the most accurate, comprehensive, and up-to-date measurement of the malaria disease burden in Uganda.
“Our findings suggest that current efforts at controlling malaria may not be as effective as previously believed in high-transmission areas, where the disease is the biggest threat,” said Grant Dorsey, MD, PhD, of the University of California, San Francisco.
“It’s important to tell the less happy story that we have not yet seen advances in more rural areas, including at least 2 sites in Uganda, where transmission has been historically high.”
To reach an accurate assessment of the malaria incidence in Uganda, Dr Dorsey and his colleagues gathered comprehensive surveillance data over 24 months, from August 2011 to September 2013.
Ultimately, the team evaluated 703 children between the ages of 6 months and 10 years. The children were randomly selected from 3 areas of Uganda with differing malaria characteristics.
The researchers found the incidence of malaria infection decreased in the relatively low-transmission, peri-urban Walukuba area during the study period—from an average of 0.51 to 0.31 episodes of malaria per person per year (P=0.001).
However, the incidence increased in the 2 rural areas. Episodes of malaria per person per year rose from an average of 0.97 to 1.93 (P<0.001) in the moderate-transmission area of Kihihi and rose from an average of 2.33 to 3.30 (P<0.001) in Nagongera, a high-transmission rural area near the southeastern border with Kenya.
Throughout the study period, families were provided with bednets and had access to 24-hour medical care free of charge at a designated study clinic for episodes of fever. The children were also routinely tested for malaria every 3 months, whether they had symptoms or not.
In addition, the researchers collected mosquito specimens monthly from light traps that were strategically placed in each house to estimate the percentages of malaria-carrying mosquitoes in the study areas.
Healthcare workers provided over 2500 treatments for malaria over the course of the study.
“Children in our study experienced a significantly high rate of infection, and that rate increased in the 2 rural areas,” Dr Dorsey said. “Based on prior data, our higher transmission sites are very likely to be representative of most of Uganda and perhaps of most other rural areas in sub-Saharan Africa as well.”
The researchers said these results suggest a need to further scale up campaigns to distribute insecticide-treated bednets and spray homes with insecticides. And high-transmission countries like Uganda may also require new interventions, such as using malaria drugs for prevention and controlling mosquito larvae, in order to match the malaria reduction successes seen elsewhere in the world.
In a related editorial, Steven Meshnick, MD, PhD, of the University of North Carolina, Chapel Hill, wrote, “The real take-home message of this study may be that malaria control in Africa requires sustained and consistent efforts over much more than 2 years.”