Correlation and epidemiologic distribution of emerging coinfections of Plasmodium falciparum and dengue virus among febrile children in malaria-endemic zones in western Kenya

Objectives

To determine correlation and epidemiological distribution of emerging coinfections of Plasmodium falciparum and dengue fever among febrile children in malaria endemic zones in western Kenya.

Methods

Prospective cohort study. This study was conducted in Kisumu and Busia Counties in western Kenya. Kisumu County is an urban setting, whereas Busia has peri-urban and rural settings. All the level 2-4 public health facilities in Kisumu central subcounty and Bunyala subcounty in Busia were included. The number of participants recruited per facility was based on the facility level proportions. From each facility level, 18 and 19 participants were recruited in Kisumu and Busia, respectively. A total of 380 febrile children aged below 5 years who screened positive for malaria and/or dengue virus and whose parents/guardians gave consent to participate were recruited. Demographic parameters were simultaneously analyzed. Statistical analysis was performed using the chi-square test.

Results

Of the 1004 participants screened, 380 turned seropositive for either malaria or dengue or coinfected. The overall disease burden was 37.8% (380 of 1004). The prevalence of P. falciparum, dengue and coinfections were 21.4% (215 of 1004), 8.9% (90 of 1004), and 7.5% (75 of 1004), respectively. Busia had the highest P. falciparum–only infections (31% [118 of 380]), whereas Kisumu had the highest dengue-only infections (16.6% [63 of 380]). The distribution of these diseases was not random across the counties but rather associated with the location (X² = 19.45, P <0.001). At the county level, differences in prevalence were statistically significant for dengue (P = 0.038) and malaria (P <0.001).

Conclusion

This study finding is suggestive of an active spread of dengue virus infections, leading to coinfections in this geographical region where malaria is endemic. The high temperatures, precipitation, and humidity experienced around Lake Victoria is favoring mosquito vector multiplication, hence the sustained mosquito transmitted disease burden. It is also important to educate clinicians on the differential diagnoses for appropriate case management because the disease patterns vary meaningfully between the two study sites.