ArticleBMC medicine2019
Observational study: 27 years of severe malaria surveillance in Kilifi, Kenya.
Article in BMC medicine, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 33 papers, 2 of them syntheses that pooled it.
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Who cites it
33 citing papers in PubMed, 2 syntheses or guidelines pooled it, 61 citations in OpenAlex.
- Identification of acute kidney injury in African children hospitalized with malaria: a multinational individual participant data meta-analysis.BMC medicine · 2026Pooled it
- Pooled it
- Identifying prognostic factors of severe metabolic acidosis and uraemia in African children with severe falciparum malaria: a secondary analysis of a randomized trial.Malaria journal · 2021Trial
- Sevuparin in children with severe malaria: a phase I safety and dose-finding trial.Nature communications · 2026Article
- Treatment outcome and associated factors of severe malaria among admitted children in the Gambella Region, Southwest Ethiopia: a retrospective study design.Malaria journal · 2026Article
- Using sentinel surveillance system data to characterize severe malaria illness and quality of malaria case management among hospitalized patients in Kenya, 2017-2024.Malaria journal · 2026Article
- Article
- A "Familiar Foe Revisited": examining the relationship between endemic Burkitt's lymphoma and changing malaria admissions in the coastal region of Kenya.BMC cancer · 2025Article
- Identification of acute kidney injury in African children with severe malaria: a multinational individual participant data meta-analysis.Research square · 2025Article
- Malaria-Associated Mortality in the 19th Century.The American journal of tropical medicine and hygiene · 2025Article
- Inpatient and postdischarge mortality among children with anaemia and malaria parasitaemia in Kenya: a cohort study.BMJ global health · 2024Article
- Neurological Symptoms and Cause of Death Among Young Children in Low- and Middle-Income Countries.JAMA network open · 2024Article
- Severe outcomes of malaria in children under time-varying exposure.Nature communications · 2024Article
- Inter-individual and inter-regional variability of breast milk antibody reactivity to bacterial lipopolysaccharides.Frontiers in immunology · 2024Article
- Extracellular vesicles could be a putative posttranscriptional regulatory mechanism that shapes intracellular RNA levels in Plasmodium falciparum.Nature communications · 2023Article
- Article
- Limited genetic variations of the Rh5-CyRPA-Ripr invasion complex inFrontiers in tropical diseases · 2023Article
- Article
- Maintenance of high temporal Plasmodium falciparum genetic diversity and complexity of infection in asymptomatic and symptomatic infections in Kilifi, Kenya from 2007 to 2018.Malaria journal · 2022Article
- Incidence of chikungunya virus infections among Kenyan children with neurological disease, 2014-2018: A cohort study.PLoS medicine · 2022Article
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Authors and funding
26 authors at 4 institutions in 2 countries.
Funding
Abstract
backgroundMany parts of Africa have witnessed reductions in Plasmodium falciparum transmission over the last 15 years. Since immunity to malaria is acquired more rapidly at higher transmission, the slower acquisition of immunity at lower transmission may partially offset the benefits of reductions in transmission. We examined the clinical spectrum of disease and predictors of mortality after sustained changes in transmission intensity, using data collected from 1989 to 2016.
methodsWe conducted a temporal observational analysis of 18,000 children, aged 14 days to 14 years old, who were admitted to Kilifi County Hospital, Kenya, from 1989 to 2016 with malaria. We describe the trends over time of the clinical and laboratory criteria for severe malaria and associated risk of mortality.
resultsDuring the time periods 1989-2003, 2004-2008, and 2009-2016, Kilifi County Hospital admitted averages of 657, 310, and 174 cases of severe malaria per year including averages of 48, 14, and 12 malaria-associated deaths per year, respectively. The median ages in years of children admitted with cerebral malaria, severe anaemia, and malaria-associated mortality were 3.0 (95% confidence interval (CI) 2.2-3.9), 1.1 (95% CI 0.9-1.4), and 1.1 (95% CI 0.3-2.2) in the year 1989, rising to 4.9 (95% CI 3.9-5.9), 3.8 (95% CI 2.5-7.1), and 5 (95% CI 3.3-6.3) in the year 2016. The ratio of children with cerebral malaria to severe anaemia rose from 1:2 before 2004 to 3:2 after 2009. Hyperparasitaemia was a risk factor for death after 2009 but not in earlier time periods.
conclusionDespite the evidence of slower acquisition of immunity, continued reductions in the numbers of cases of severe malaria resulted in lower overall mortality. Our temporal data are limited to a single site, albeit potentially applicable to a secular trend present in many parts of Africa.
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