Research
Prevalence of plasmodium falciparum in active conflict areas of eastern Burma: a summary of cross-sectional data
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* Corresponding author: Adam K Richards arichar2@jhmi.edu
1 Department of Internal Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, 305 East 161st Street, Bronx, USA 10451
2 Global Health Access Program, Mae Sot, Thailand
3 Planet Care/Global Health Access Program, 801 Cedar Street Suite 200, Berkeley, CA, USA 94710
4 Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, USA 21205
5 The MENTOR Initiative-Liberia, Monrovia, Liberia
6 15806 East Saratoga Place Aurora, CO 80015 USA
7 Backpack Health Worker Team, 659, Moo 1 – Thasailuad, Mae Sot, Tak, Thailand, 63110
8 Karen Department of Health and Welfare, No. 663 Moo 1 – Thasailuad, Asia High Way, Mae Sot, Tak, Thailand 63110
9 Department of Medicine, University of California at Los Angeles, 924 Westwood Blvd. Suite 300, Los Angeles, CA, USA 90024
Conflict and Health 2007, 1:9 doi:10.1186/1752-1505-1-9
Published: 5 September 2007Abstract
Background
Burma records the highest number of malaria deaths in southeast Asia and may represent a reservoir of infection for its neighbors, but the burden of disease and magnitude of transmission among border populations of Burma remains unknown.
Methods
Plasmodium falciparum (Pf) parasitemia was detected using a HRP-II antigen based rapid test (Paracheck-Pf®). Pf prevalence was estimated from screenings conducted in 49 villages participating in a malaria control program, and four retrospective mortality cluster surveys encompassing a sampling frame of more than 220,000. Crude odds ratios were calculated to evaluate Pf prevalence by age, sex, and dry vs. rainy season.
Results
9,796 rapid tests were performed among 28,410 villagers in malaria program areas through four years (2003: 8.4%, 95% CI: 8.3 – 8.6; 2004: 7.1%, 95% CI: 6.9 – 7.3; 2005:10.5%, 95% CI: 9.3 – 11.8 and 2006: 9.3%, 95% CI: 8.2 – 10.6). Children under 5 (OR = 1.99; 95% CI: 1.93 – 2.06) and those 5 to 14 years (OR = 2.24, 95% CI: 2.18 – 2.29) were more likely to be positive than adults. Prevalence was slightly higher among females (OR = 1.04, 95% CI: 1.02 – 1.06) and in the rainy season (OR = 1.48, 95% CI: 1.16 – 1.88). Among 5,538 rapid tests conducted in four cluster surveys, 10.2% were positive (range 6.3%, 95% CI: 3.9 – 8.8; to 12.4%, 95% CI: 9.4 – 15.4).
Conclusion
Prevalence of plasmodium falciparum in conflict areas of eastern Burma is higher than rates reported among populations in neighboring Thailand, particularly among children. This population serves as a large reservoir of infection that contributes to a high disease burden within Burma and likely constitutes a source of infection for neighboring regions.