PERIODICITY AND SPACE-TIME CLUSTERING OF SEVERE CHILDHOOD MALARIA ON THE COAST OF KENYA

Traditionally malaria epidemiology has focused on factors such as para site rates and vector dynamics without specific reference to disease. There are limited comprehensive data on malaria as a life-threatening event in African children. We have identified, through hospital survei llance, 581 episodes of severe malaria in residents of a defined area on the Kenya coast over a period of 3 years. This represents an absolu te minimum risk of developing severe malaria by the fifth birthday of 1 in 15. The presentation of severe malaria showed marked seasonality, but the timing and magnitude of these fluctuations varied considerabl y between years. A satellite navigational system was used to define th e exact location of the home of each severe malaria case. Space-time c lustering of severe malaria was evident in this community. Seasonal pe aks in incidence of severe malaria may comprise discrete mini-epidemic s. In contrast, parasite rates in the community varied little during t he course of the surveillance. The monitoring of disease, as opposed t o parasitization, in children may result in more effective targeting o f intervention resources.