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      The co-distribution of Plasmodium falciparum and hookworm among African schoolchildren

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          Abstract

          Background

          Surprisingly little is known about the geographical overlap between malaria and other tropical diseases, including helminth infections. This is despite the potential public health importance of co-infection and synergistic opportunities for control.

          Methods

          Statistical models are presented that predict the large-scale distribution of hookworm in sub-Saharan Africa (SSA), based on the relationship between prevalence of infection among schoolchildren and remotely sensed environmental variables. Using a climate-based spatial model of the transmission potential for Plasmodium falciparum malaria, adjusted for urbanization, the spatial congruence of populations at coincident risk of infection is determined.

          Results

          The model of hookworm indicates that the infection is widespread throughout Africa and that, of the 179.3 million school-aged children who live on the continent, 50.0 (95% CI: 48.9–51.1) million (27.9% of total population) are infected with hookworm and 45.1 (95% CI: 43.9–46) million are estimated to be at risk of coincident infection.

          Conclusion

          Malaria and hookworm infection are widespread throughout SSA and over a quarter of school-aged children in sub-Saharan Africa appear to be at risk of coincident infection and thus at enhanced risk of clinical disease. The results suggest that the control of parasitic helminths and of malaria in school children could be viewed as essential co-contributors to promoting the health of schoolchildren.

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          Most cited references47

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          The global distribution of clinical episodes of Plasmodium falciparum malaria.

          Interest in mapping the global distribution of malaria is motivated by a need to define populations at risk for appropriate resource allocation and to provide a robust framework for evaluating its global economic impact. Comparison of older and more recent malaria maps shows how the disease has been geographically restricted, but it remains entrenched in poor areas of the world with climates suitable for transmission. Here we provide an empirical approach to estimating the number of clinical events caused by Plasmodium falciparum worldwide, by using a combination of epidemiological, geographical and demographic data. We estimate that there were 515 (range 300-660) million episodes of clinical P. falciparum malaria in 2002. These global estimates are up to 50% higher than those reported by the World Health Organization (WHO) and 200% higher for areas outside Africa, reflecting the WHO's reliance upon passive national reporting for these countries. Without an informed understanding of the cartography of malaria risk, the global extent of clinical disease caused by P. falciparum will continue to be underestimated.
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            Urbanization, malaria transmission and disease burden in Africa.

            Many attempts have been made to quantify Africa's malaria burden but none has addressed how urbanization will affect disease transmission and outcome, and therefore mortality and morbidity estimates. In 2003, 39% of Africa's 850 million people lived in urban settings; by 2030, 54% of Africans are expected to do so. We present the results of a series of entomological, parasitological and behavioural meta-analyses of studies that have investigated the effect of urbanization on malaria in Africa. We describe the effect of urbanization on both the impact of malaria transmission and the concomitant improvements in access to preventative and curative measures. Using these data, we have recalculated estimates of populations at risk of malaria and the resulting mortality. We find there were 1,068,505 malaria deaths in Africa in 2000 - a modest 6.7% reduction over previous iterations. The public-health implications of these findings and revised estimates are discussed.
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              Incorporating a Rapid-Impact Package for Neglected Tropical Diseases with Programs for HIV/AIDS, Tuberculosis, and Malaria

              Hotez et al. argue that achieving success in the global fight against HIV/AIDS, tuberculosis, and malaria may well require a concurrent attack on the neglected tropical diseases.
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                Author and article information

                Journal
                Malar J
                Malaria Journal
                BioMed Central (London )
                1475-2875
                2006
                3 November 2006
                : 5
                : 99
                Affiliations
                [1 ]Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, UK
                [2 ]Schistosomiasis Control Initiative, Imperial College, London, UK
                [3 ]Department of Microbiology and Tropical Medicine, The George Washington University, Washington DC, USA
                [4 ]Spatial Ecology and Epidemiology Research Group, Department of Zoology, University of Oxford, Oxford, UK
                [5 ]Malaria Public Health and Epidemiology Group, Centre for Geographic Medicine. KEMRI/Wellcome Trust Research Laboratories, Nairobi, Kenya
                [6 ]Human Development Division, The World Bank, Washington DC, USA
                [7 ]Centre for Tropical Medicine, University of Oxford, Oxford, UK
                [8 ]Division of Epidemiology and Social Medicine, School of Population Health, University of Queensland, Herston, Queensland, Australia
                Article
                1475-2875-5-99
                10.1186/1475-2875-5-99
                1635726
                17083720
                c4add931-c887-41bd-9381-bd1d5923c98c
                Copyright © 2006 Brooker et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 15 October 2006
                : 3 November 2006
                Categories
                Research

                Infectious disease & Microbiology
                Infectious disease & Microbiology

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