ArticleMalaria journal2025
Malaria outbreak facilitated by increased vector-breeding sites from erosion control pits sustained by intermittent rainfall, Mbale District, Uganda, January-June 2019.
Article in Malaria journal, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundIn June 2019, the Uganda Ministry of Health, through routine surveillance data analysis, was notified of an increase in malaria cases in Mbale District, which exceeded the outbreak action thresholds. This investigation was conducted to assess the magnitude of the outbreak, identify transmission risk factors, and recommend evidence-based control measures.
methodsA confirmed case was defined as a positive malaria result using a malaria rapid diagnostic test or microscopy from 1 January 2019 to 30 June 2019 in a resident or visitor of Bumbobi or Nyondo Sub-County, Mbale District. Medical records were reviewed to develop a line list for descriptive epidemiology. Using a case-control study, exposures were compared between 150 case-persons and 150 asymptomatic controls matched by age and village. Environmental and entomological assessments on vector dynamics were further conducted.
resultsEight thousand eight hundred twenty-seven case-patients (attack rate [AR] = 33%) were identified. Females (AR = 36%) were more affected than males (AR = 27%). The 5-18-year age group (AR = 2.6%) was most affected. The epidemic curve showed a steady increase in malaria cases in March, peaking 4 weeks after the last peak of rainfall. In the matched pair case-control analysis, 95% (143/150) of case-patients and 49% (73/150) of controls had soil erosion control pits that held stagnant water near their homes for several days following rainfall (OR = 18, 95% CI 7.0-50); 31% (47/150) of case-patients and 72% (108/150) of controls wore long-sleeve clothes during evening hours (OR = 0.19, 95% CI 0.08-0.3); 69% (104/150) of case-patients and 92% (138/150) of controls slept under a bed net (OR = 0.17, 95% CI 0.07-0.38). Active breeding sites were found near and within homesteads with Anopheles gambiae as the predominant vector.
conclusionIncreased vector breeding sites due to erosion control pits as a soil conservation practice sustained by the intermittent rainfall, likely caused this outbreak. Draining pits immediately after the rains and increasing coverage for bed nets were recommended.
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