Spatial heterogeneity of malaria in Ghana: A cross-sectional study on the association between urbanicity and the acquisition of immunity

Clemens Frank, Ralf Krumkamp, Nimako Sarpong, Peter Sothmann, Julius N. Fobil, Geoffrey Foli, Anna Jaeger, Lutz Ehlkes, Ellis Owusu-Dabo, Yaw Adu-Sarkodie, Florian Marks, Ralf R. Schumann, Jürgen May, Benno Kreuels

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13 Citations (Scopus)

Abstract

Background: Malaria incidence has declined considerably over the last decade. This is partly due to a scale-up of control measures but is also attributed to increasing urbanization. This study aimed to analyse the association between malaria and urbanization and the effect of urbanicity on the acquisition of semi-immunity. Methods: In 2012, children with fever presenting to St Michael's Hospital Pramso/Ghana were recruited. The malaria-positive-fraction (MPF) of fever cases was calculated on community-level to approximate the malaria risk. The mean age of malaria cases was calculated for each community to estimate the acquisition of semi-immunity. The level of urbanicity for the communities was calculated and associations between MPF, urbanicity and immunity were modelled using linear regression. Results: Twenty-six villages were included into the study with a mean MPF of 35 %. A linear decrease of 5 % (95 % CI: 4-6 %) in MPF with every ten-point increase in urbanicity was identified. The mean age of malaria patients increased by 2.9 months (95 % CI: 1.0-4.8) with every ten-point increase in urbanicity. Discussion: The results confirm an association between an increase in urbanicity and declining malaria risk and demonstrate that the acquisition of semi-immunity is heterogeneous on a micro-epidemiological scale and is associated with urbanicity.

Original languageEnglish
Article number84
JournalMalaria Journal
Volume15
Issue number1
DOIs
Publication statusPublished - 11 Feb 2016

Keywords

  • Children
  • Ghana
  • Malaria
  • Semi-immunity
  • Urbanization

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