Despite recent successes in control efforts, malaria remains one of the main causes of febrile illness and a leading cause of child mortality in malaria endemic countries of sub-Saharan Africa. Successful control of malaria depends upon a detailed knowledge of its epidemiology, including knowledge of the social and economic factors that influence its prevalence. A study carried in The Gambia about 20 years at a time when malaria transmission was moderately intense found that malaria was associated with poor quality housing and crowding. Now that malaria transmission in The Gambia has reduced substantially and age distribution has shifted to older children, it is important to re-examine the role of individual risk factors for uncomplicated malaria in this setting. During 2011 malaria transmission season a case control study began to identify individual risk factors for malaria and determine the spatial and temporal distribution of cases of malaria using GIS in a setting of very low malaria incidence.
Cases are enrolled from the OPD Clinics in Western Region of The Gambia. Community controls are selected from the neighbourhood of malaria cases during home visits. A questionnaire is administered to each parent to document socioeconomic status, literacy, knowledge and awareness of malaria prevention, highest level of education attained, distance, and ease of access, to the nearest health facility, recent antimalarial intake, recent travel outside the study area and occupation. The geographic coordinates of the compound is measured using a GPS devise.
95 cases and 95 controls have been enrolled into the study at two hospitals in peri-urban areas near the capital Banjul. The required sample size is 150 cases and recruitment will continue during the 2012 malaria transmission season which is now under way. Recruitment will completed by December 2012. The project has provided epidemiological training for Dr Lama, a Guinean physician who spent four months with the team in The Gambia during the 2011 malaria transmission season.