Malaria Diagnosed in an Urban Setting Strongly Associated with Recent Overnight Travel: A Case–Control Study from Kampala, Uganda

Abstract

Malaria is frequently diagnosed in urban Kampala, despite low transmission intensity. To evaluate the association between recent travel out of Kampala and malaria, we conducted a matched case-control study. Cases were febrile outpatients with a positive malaria test; controls were febrile outpatients with a negative test. For every two cases, five controls were selected, matching on age. Data were collected on recent overnight travel out of Kampala (past 60 days), destination and duration of travel, and behavioral factors, including sleeping under an insecticide-treated net (ITN) during travel. From July to August 2019, 162 cases and 405 controls were enrolled. The locations of residence of cases and controls were similar. More controls were female (62.7% versus 46.3%, P < 0.001). Overall, 158 (27.9%) participants reported recent overnight travel. Travelers were far more likely to be diagnosed with malaria than those who did not travel (80.

Challenges and opportunities for use of long-lasting insecticidal nets to prevent malaria during overnight travel in Uganda: a qualitative study

“…Patients presenting to the outpatient department laboratory for a malaria test during the day who were not very weak were approached for participation in the study as previously described elsewhere [8]. Brie y, patients were enrolled in a case-control study as cases if they had a positive test for malaria and those with a negative test as controls until 162 cases and 405 controls were enrolled.…”

“…While substantial progress has been made in the control of malaria in Africa, much remains to be done to achieve prevention among travellers [3,4]. Malaria transmission has become relatively low in many urban areas [5][6][7], resulting in urban residents having relatively low immunity, and so being at particular risk of malaria infection when they travel to rural areas [8]. There are proven malaria prevention measures, including use of long lasting insecticidal nets (LLINs), that are recommended for travellers from low to high malaria endemic areas [9].…”

“…Usage has been reported to be low in residents who travel from areas of relatively low to high malaria risk [1,10]. A study conducted in Uganda showed that Kampala residents who travelled overnight out of the city were at substantially higher risk of malaria with women less likely to use LLINs during travel than men [8]. However, information on use of malaria preventive measures in travellers is limited [15].…”

“…We analysed local perceptions and attitudes regarding use of LLINs and other malaria prevention practices among individuals travelling from Kampala to other parts of Uganda. The study was embedded in a case control study that evaluated the association between malaria and overnight travel from Kampala [8].…”

Challenges and opportunities for use of long-lasting insecticidal nets to prevent malaria during overnight travel in Uganda: a qualitative study

“…While substantial progress has been made in the control of malaria in Africa, much remains to be done to achieve prevention among travellers [ 3 , 4 ]. Malaria transmission has become relatively low in many urban areas [ 5 – 7 ], resulting in urban residents having relatively low immunity, and so being at particular risk of malaria infection when they travel to rural areas [ 8 ]. There are proven malaria prevention measures, including use of long-lasting insecticidal nets (LLINs), that are recommended for travellers from low to highly malaria-endemic areas [ 9 ].…”