defining clinical malaria the specificity and incidence of endpoints from active and passive surveillance of children in rural kenya端点定义特异性和临床疟疾发病率从主动和被动监测肯尼亚农村的孩子.pdfVIP

Defining Clinical Malaria: The Specificity and Incidence of Endpoints from Active and Passive Surveillance of Children in Rural Kenya 1 1,2 1 3 1 1 Ally Olotu *, Gregory Fegan , Thomas N. Williams , Philip Sasi , Edna Ogada , Evasius Bauni , Juliana Wambua1, Kevin Marsh1,2, Steffen Borrmann1,4., Philip Bejon1,2. 1 Kenya Medical Research Institute/Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya, 2 Nuffield Department of Medicine, Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Oxford, United Kingdom, 3 Department of Clinical Pharmacology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, 4 Department of Infectious Diseases, Heidelberg University School of Medicine, Heidelberg, Germany Abstract Background: Febrile malaria is the most common clinical manifestation of P. falciparum infection, and is often the primary endpoint in clinical trials and epidemiological studies. Subjective and objective fevers are both used to define the endpoint, but have not been carefully compared, and the relative incidence of clinical malaria by active and passive case detection is unknown. Methods: We analyzed data from cohorts under active and passive surveillance, including 19,462 presentations with fever and 5,551 blood tests for asymptomatic parasitaemia. A logistic regression model was used to calculate Malaria Attributable Fractions (MAFs) for various case definitions. Incidences of febrile malaria by active and passive surveillance were compared in a subset of children matched for age and location. Results: Active surveillance identified three times the incidence of clinical malaria as passive surveillance in a subset o