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

Fever treatment in the absence of malaria transmission in an urban informal settlement in Nairobi, Kenya
Fever treatment in the absence of malaria transmission in an urban informal settlement in Nairobi, Kenya
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.
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.
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.
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 planners
1475-2875
160-[7pp]
Ye, Yazoume
b989f1d8-573e-4b64-a5b9-52d593bdf096
Madise, Nyovani
2ea2fbcc-50da-4696-a0a5-2fe01db63d8c
Ndugwa, Robert
5a700daa-39bc-43fb-af1b-dc269e977011
Ochola, Sam
9b86feeb-af14-4d62-aeb3-748656dbae37
Snow, Robert W.
7ff98228-6657-4b33-9793-b7f91a06c187
Ye, Yazoume
b989f1d8-573e-4b64-a5b9-52d593bdf096
Madise, Nyovani
2ea2fbcc-50da-4696-a0a5-2fe01db63d8c
Ndugwa, Robert
5a700daa-39bc-43fb-af1b-dc269e977011
Ochola, Sam
9b86feeb-af14-4d62-aeb3-748656dbae37
Snow, Robert W.
7ff98228-6657-4b33-9793-b7f91a06c187

Ye, Yazoume, Madise, Nyovani, Ndugwa, Robert, Ochola, Sam and Snow, Robert W. (2009) Fever treatment in the absence of malaria transmission in an urban informal settlement in Nairobi, Kenya. Malaria Journal, 8, 160-[7pp]. (doi:10.1186/1475-2875-8-160).

Record type: Article

Abstract

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.
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.
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.
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 planners

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Published date: 2009

Identifiers

Local EPrints ID: 71062
URI: http://eprints.soton.ac.uk/id/eprint/71062
ISSN: 1475-2875
PURE UUID: de3d46a1-0145-40fb-9c8b-07bcf6541d51
ORCID for Nyovani Madise: ORCID iD orcid.org/0000-0002-2813-5295

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Date deposited: 14 Jan 2010
Last modified: 13 Mar 2024 20:19

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Contributors

Author: Yazoume Ye
Author: Nyovani Madise ORCID iD
Author: Robert Ndugwa
Author: Sam Ochola
Author: Robert W. Snow

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