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Volume 12, Number 10—October 2006

Perspective

Malaria Epidemics and Interventions, Kenya, Burundi, Southern Sudan, and Ethiopia, 1999–2004

Francesco Checchi*†Comments to Author , Jonathan Cox†, Suna Balkan‡, Abiy Tamrat§, Gerardo Priotto*, Kathryn Alberti*, Dejan Zurovac‡¶#, and Jean-Paul Guthmann*
Author affiliations: *Epicentre, Paris, France; †London School of Hygiene and Tropical Medicine, London, United Kingdom; ‡Médecins Sans Frontières, Paris, France; §Médecins Sans Frontières, Geneva, Switzerland; ¶Kenya Medical Research Institute/Wellcome Trust Research Laboratories, Nairobi, Kenya; #University of Oxford, Oxford, United Kingdom

Main Article

Table 1

Characteristics of intervention sites and potential determinants of epidemics*

Characteristic/ determinant Kisii/Gucha, Kenya Kayanza, Burundi Aweil East, southern Sudan Gutten, Ethiopia Damot Gale, Ethiopia
Epidemic period (no. weeks) May–August 1999 (15) September 2000–May 2001 (36) June–November 2003 (22) July 2003–February 2004 (33) July 2003–January 2004 (30)
Population 956,000 578,000 307,000 44,000 287,000
Altitude (m) 1,200–2,200 1,400–1,750 430 1,700 1,600–2,100
Malaria vectors Anopheles funestus (constant), A. gambiae sensu lato (seasonal) A. arabiensis (95%), A. funestus (5%) Not available (A. gambiae sensu lato presumed) A. arabiensis A. arabiensis
Malaria species (nonepidemic months) Plasmodium falciparum (>90%) P. falciparum (>90%) P. falciparum (>95%) P. falciparum (≈25%), P. vivax (≈75%) P. falciparum (≈60%), P. vivax (≈40%)
Temperature anomalies Above average in 3 preepidemic months None apparent Maximum LST strongly below average during epidemic None apparent None apparent
Rainfall anomalies Heavy rainfall in preepidemic rainy season after drought in previous rainy season Heavy rainfall 5 and 3 months before epidemic, drought 2 years before epidemic but not in preepidemic year Below average rainfall in 3 preepidemic years, above average in 2 preepidemic months Below average rainfall in 2 preepidemic and epidemic years but heavy rainfall in preepidemic month Below average rainfall in 2 preepidemic and epidemic years but heavy rainfall in 3 preepidemic months
Land pattern changes None reported Creation of rice paddies and fish ponds Widespread flooding Creation of water ponds None reported
Political instability None Armed conflict Tenuous ceasefire Inactive insurgency Inactive insurgency
Population movement None Forced relocation Seminomadic, returnees from north Sudan Government resettlement schemes Government resettlement schemes
Global acute malnutrition† Not available 10%–15% 25% Not available (probably >5%) 28%
Drug resistance (in vivo failure rates) CQ 24%–87% (neighboring districts), SP 10% (13) CQ 100%, SP 54.2%, CQ+SP 42.0% (9) CQ 63%, SP 3% (14)‡ SP 78.0% (15) SP 68.1% (neighboring zone) (15)

*LST, land surface temperature; CQ, chloroquine; SP, sulfadoxine-pyrimethamine.
†Among children <5 y of age; malnutrition rates >15% denote a serious situation; values are provided for 2 months before the epidemic.
‡Percentages refer to the frequency of single Pfcrt mutations and triple Dhfr mutations in the P. falciparum genome of outpatients sampled in Aweil East. These mutations are predictive of in vivo CQ and SP failure rates, respectively.

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