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Fever treatment in the absence of malaria transmission in an urban informal settlement in Nairobi, Kenya

By Yazoume Ye, Nyovani Madise, Robert Ndugwa, Sam Ochola and Robert W. Snow


Background: in sub-Saharan Africa, knowledge of malaria transmission across rapidly proliferating urban centres and recommendations for its prevention or management remain poorly defined. This paper presents the results of an investigation into infection prevalence and treatment of recent febrile events among a slum population in Nairobi, Kenya.<br/>Methods: in July 2008, a community-based malaria parasite prevalence survey was conducted in Korogocho slum, which forms part of the Nairobi Urban Health and Demographic Surveillance system. Interviewers visited 1,069 participants at home and collected data on reported fevers experienced over the preceding 14 days and details on the treatment of these episodes. Each participant was tested for malaria parasite presence with Rapid Diagnostic Test (RDT) and microscopy. Descriptive analyses were performed to assess the period prevalence of reported fever episodes and treatment behaviour.<br/>Results: of the 1,069 participants visited, 983 (92%) consented to be tested. Three were positive for Plasmodium falciparum using RDT; however, all were confirmed negative on microscopy. Microscopic examination of all 953 readable slides showed zero prevalence. Overall, from the 1,004 participants who have data on fever, 170 fever episodes were reported giving a relatively high period prevalence (16.9%, 95% CI:13.9%–20.5%) and higher among children below five years (20.1%, 95%CI:13.8%–27.8%). Of the fever episodes with treatment information 54.3% (95%CI:46.3%–62.2%) were treated as malaria using mainly sulphadoxine-pyrimethamine or amodiaquine, including those managed at a formal health facility. Only four episodes were managed using the nationally recommended first-line treatment, artemether-lumefantrine.<br/>Conclusion: the study could not demonstrate any evidence of malaria in Korogocho, a slum in the centre of Nairobi. Fever was a common complaint and often treated as malaria with anti-malarial drugs. Strategies, including testing for malaria parasites to reduce the inappropriate exposure of poor communities to expensive anti-malarial drugs provided by clinical services and drug vendors, should be a priority for district planner

Topics: HN, RA0421, DT
Year: 2009
OAI identifier:
Provided by: e-Prints Soton

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  1. (1949). A parasitological survey of African school children n Nairobi schools with haematological results of malaria infection. Trop Med Hyg
  2. (1987). A: Malaria and urbanization in Central Africa: the example of Brazzaville. Part III: Relationships between urbanization and the intensity of malaria transmission. Trans R Soc Trop Med Hyg doi
  3. (2008). A: The impact of response to the results of diagnostic tests for malaria: cost-benefit analysis. BMJ doi
  4. (2007). Akhwale WS, Snow RW: The challenges of changing national malaria drug policy to artemisinin-based combinations in Kenya. Malar J doi
  5. (2007). Assessing the risk of selfdiagnosed malaria in urban informal settlements using selfreported morbidity survey. doi
  6. (2004). BH: Integrated urban malaria control: a case study in Dar Es Salaam, Tanzania. Am J Trop Med Hyg.
  7. (2004). BH: Urbanization in sub-Saharan Africa and implication for malaria control. Am J Trop Med Hyg
  8. (1999). Bureau of Statistic-KNBS:
  9. (1984). C: Clinical malaria in Nairobi. East African Med J
  10. (1949). Demographic survey of the British Colonial Empire. doi
  11. (2005). Ezeh AC: A qualitative assessment of social support in urban poor settings of Nairobi. doi
  12. (2008). GF: A tool box for operational mosquito larval control: preliminary results and early lessons from the Urban Malaria Control Programme in Dar es Salaam, Tanzania. Malar J doi
  13. (2006). Health, Kenya: National Guidelines for diagnosis, treatment and prevention of malaria for health workers in Kenya. Division of Malaria Control (DOMC), Ministry of Health, Republic of Kenya,
  14. (2001). Information Systems Kenya: Ministry of Heath Report,
  15. (2003). JC: Malaria transmission in urban sub-Saharan Africa. Am J Trop Med Hyg
  16. (1947). JP: Some aspects of Malaria in Kenya.
  17. (1940). Malaria in Nairobi.
  18. (2008). Mills A: Cost-effectiveness of malaria diagnostic methods in subSaharan Africa in an era of combination therapy. Bull World Health Organ doi
  19. (2008). MJ: Impact of urban agriculture on malaria vectors in doi
  20. (2005). Mutero C: Malaria and urbanization in sub-Saharan Africa. Malar J doi
  21. (1971). Nyawade ZN: &quot;Clinical malaria&quot; in Nairobi. East African Med J
  22. (1986). Prevalence of malaria in Ouagadougou and the surrounding rural environment during the period of maximal transmission. Parassitologia
  23. Protectorate of Kenya (CPK) (1908–1966): Medical and Sanitation Department Annual Reports Government of Kenya.
  24. (2005). Rapid urban malaria appraisal (RUMA) I: epidemiology of urban malaria in Ouagadougou. Malar J doi
  25. (2006). Rapid urban malaria appraisal (RUMA) II: Epidemiology of urban malaria in Dar es Salaam (Tanzania). Malar J doi
  26. (2006). RW: Microscopy and outpatient malaria case management among older children and adults in Kenya. Trop Med Int Health. doi
  27. (2005). Snow RW: The influence of urbanization on measures of Plasmodium falciparum infection prevalence in East Africa. Acta Trop doi
  28. (2005). Snow RW: Urbanization, malaria transmission and disease burden in Africa. Nat Rev Microbiol doi
  29. (2000). SQL Server 2000: The Complete Reference. Edition: illustrated, Osborne/McGraw Hill;
  30. (2005). Stata corporation: Statistic Sofware: Release 9.1 Collage Station Texas Stata Corporation;
  31. Studies on malaria and its vectors in Nairobi: A Review of the distribution of the vectors and the prevalence of the disease
  32. (2004). Taffa N: The triad of poverty, environment and child health in Nairobi's informal settlements.
  33. (2008). The Burden of disease profile of residents of Nairobi's slums: Results from a Demographic Surveillance. Popul Health Metr doi
  34. (2009). Time to move from presumptive malaria treatment to laboratory-confirmed diagnosis and treatment in African children with fever. PLoS Medicine doi
  35. UN-Habitat: The Challenges of Slums- Global report on human settlements. Earthscan Publication, doi
  36. (1992). Vector density gradients and the epidemiology of urban malaria in Dakar, Senegal. Am J Trop Med Hyg
  37. (2004). Whitty CJ: Overdiagnosis of malaria in patients with severe febrile illness in Tanzania: a prospective study. BMJ
  38. (1999). Wijeyaratne P: Malaria in urban and peri-urban areas in sub-Sahara Africa.

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