malaria

The risks and severity of clinical outcomes following exposure to P. falciparum increase among older children as transmission intensity declines. Malaria control in Africa has focused on pre-school children and pregnant women over the last decade, but as transmission intensity declines school aged children will become an important clinical risk group. As a result of a historical pre-school prevention focus, we have shown that children aged 5-19 years have the lowest ITN use in any community and thus pose a threat to universal coverage targets and abilities to reduce local transmission. Our group have undertaken randomized-controlled and plausibility trials of malaria prevention among school children, notably IPTsc and the delivery of ITN to school children in hard-to-reach areas.

Unlike stable transmission settings in Africa the drivers of focal, heterogeneous infection and disease risks among the arid areas of Africa remain poorly defined. The populations in North West and North Eastern Kenya are poor, semi-nomadic groups with little acquired functional immunity to P. falciparum, marginalized by the 2001-09 national malaria strategy as they were assumed to be at no risk. Risks however, appear to be very focal concentrated in areas of seasonal water which also determines where people live. A more detailed empirical investigation of malaria risk, including susceptibility to P.

Kenya provides a unique set of opportunities to apply the principles of high-spatial resolution geo-statistical modelling with its rich prospectively collected national data on parasite prevalence, intervention coverage and associated covariates that relate to access to interventions and malaria risk. This work has already formed the basis of recent strategic planning for malaria control in Kenya and will be used to quantify the population-attributable infection risk reduction associated with scaled, spatially quantified intervention coverage to predict changing morbidity and mortality impact using appropriate epidemiological and burden of disease models for Kenya through to 2016.

Cerebral malaria, meningitis and encephalitis are the most common causes of acute encephalopathies in children in sub-Saharan Africa. All are associated with seizures and may be complicated by shock and intracranial hypertension. These features are associated with prolonged coma, increased mortality and both short and long-term cognitive and neurological deficits. Children with multiple risk factors have even poorer outcomes.

Seizures may be completely unapparent clinically. Clinical signs of intracranial hypertension are a late feature and intracranial pressure monitoring is an invasive procedure unavailable in most health units in sub-Saharan Africa.