Community-wide prevalence of malaria parasitemia in hiv-infected and uninfected populations in a high-transmission setting in Uganda

Type Journal Article - The Journal of Infectious Diseases
Title Community-wide prevalence of malaria parasitemia in hiv-infected and uninfected populations in a high-transmission setting in Uganda
Author(s)
Volume 213
Issue 12
Publication (Day/Month/Year) 2016
Page numbers 1971-1978
URL https://academic.oup.com/jid/article/213/12/1971/2572161/Community-wide-Prevalence-of-Malaria-Parasi​temia
Abstract
ackground.  Malaria control strategies depend on identifying individuals with parasitemia, who may be asymptomatic but retain the ability to transmit disease. Population-level survey data on parasitemia are limited and traditionally exclude adults and human immunodeficiency virus (HIV)–infected individuals.
Methods.  We performed a cross-sectional survey of residents aged 18 months to 94 years in Nankoma, Uganda. Blood specimens were collected using the dried blood spot technique from 9629 residents (87.6%), and samples from a subset of 4131 were tested for malaria parasites, using loop-mediated isothermal amplification. Population-level prevalence was estimated using a weighted proportion, and predictors of parasitemia were identified using a multivariate Poisson regression model.
Results.  The community prevalence of parasitemia was 83.8% (95% confidence interval [CI], 82.9%–84.6%). Parasite prevalence was highest among children aged 5–14 years (94.7%) and lowest among adults (61.9%). In analysis that controlled for age, HIV-infected individuals with an undetectable viral load had a lower risk of parasitemia, compared with HIV-uninfected individuals (adjusted relative risk, 0.16; 95% CI, .10–.27; P < .001).
Conclusions.  In a rural Ugandan community, 2 years after distribution of long-lasting insecticide-treated bed nets, the prevalence of malaria parasitemia was high across all ages, peaking in school-aged children. Persons with well-controlled HIV infection had a lower risk of parasitemia, presumably reflecting access to HIV care.

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