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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

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Table 3

Epidemiologic profile of malaria at fixed inpatient, fixed outpatient, and mobile health facilities operated by Médecins Sans Frontières in 5 intervention sites

Characteristic Kisii/Gucha, Kenya Kayanza, Burundi Aweil East, southern Sudan Gutten, Ethiopia Damot Gale, Ethiopia
Uncomplicated cases
Fixed outpatient centers
All ages 13,127* 272,459 15,239 15,928†
Age <5 y (%) 2,426 (18.5) Not available 7,257 (47.6) 4,758‡ (29.9)
Mobile clinics
All ages 29,769 46,541 34,749 7,258 467
Age <5 y (%) 5,376 (18.1) Not available 17,338 (49.9) 1,405 (19.4) 145 (31.0)
Complicated cases
All ages 9,773§ 3,953¶ 875# 330** 1,291
Age <5 y (%) 5078 (52.0) 761 (19.3) 683 (78.1) 175 (53.0) 595 (46.1)
No. deaths (CFR [%]) 397 (4.1) 108 (2.7) 50 (5.7) 34 (10.3) 62 (4.8)
No. deaths <5 y (CFR [%]) 164 (3.2) 31 (4.1) 39 (5.7) 15 (8.6) 38 (6.4)
Minimal attack rate (%)†† 22.2 (complicated, <5 only; 12/15 weeks) 86.5 (36/36 weeks) 41.2 (<5 only; 22/22 weeks) 53.4 (15/33 weeks) Not available
P. falciparum prevalence at epidemic peak (%) 38–49 (community survey) 80 (random sample in OPD queue) 52–64 (random sample in OPD‡‡ queue) Not available 60 (random sample by community workers)

*Includes data from 3 government clinics (Masimba, Kenyenya, and Etago) for which age breakdown was available.
†Includes 2,061 patients treated with intrarectal quinine in inpatient department.
‡Includes 1,773 patients <5 years of age treated with intrarectal quinine in inpatient department.
§Includes data from Kisii, Keumbu, and Ogembo hospitals, supported by Médecins Sans Frontières and other agencies but operated by the government.
¶Excludes patients treated in the Kayanza government hospital (data not available).
#Excludes 110 severe cases treated by mobile clinics (no age breakdown or outcome available).
**Includes only hospitalized patients who met a strict definition of severe malaria, which probably explains the considerably higher case-fatality ratio (CFR) noted in Gutten.
††Ratio of weeks refers to the number of epidemic weeks from which the attack rate was calculated divided by the total number of epidemic weeks.
‡‡OPD, outpatient department.

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