Relationship between altitude and intensity of malaria transmission in the Usambara Mountains, Tanzania.

There is a consensus that malaria is a growing problem in African highlands. This is surprising because many parts of the highlands were considered too cold to support transmission. In this report, we examined how transmission of Plasmodium falciparum in six villages changed along an altitude transect in the Usambara Mountains, Tanzania, from 300 m to 1700 m. Routine entomological collections were made using spray catches and light traps for 15 mo. Direct estimates of entomological inoculation rates and indirect estimates of vectorial capacity suggested a >1000-fold reduction in transmission intensity between the holoendemic lowland and the hypoendemic highland plateau. Lowland transmission was perennial with a significant peak in the cool season after the long rains in May, when vectors densities were high. In the highlands, low temperatures prevented parasite development in mosquitoes during the cool season rains, and highland transmission was therefore limited to the warm dry season when vector densities were low. The primary effect of increasing altitude was a log-linear reduction in vector abundance and, to a lesser extent, a reduction in the proportion of infective mosquitoes. Highland malaria transmission was maintained at extraordinarily low vector densities. We discuss herein the implications of these findings for modeling malaria and suggest that process-based models of malaria transmission risk should be improved by considering the direct effect of temperature on vector densities. Our findings suggest that variation in the short rains in November and changes in agricultural practices are likely to be important generators of epidemics in the Usambaras.

Diversity of Plasmodium falciparum populations and complexity of infections in relation to transmission intensity and host age: a study from the Usambara Mountains, Tanzania.

Diversity and complexity of infections with Plasmodium falciparum were described from cross-sectional surveys in November-December 1996 in 6 villages in the Usambara Mountains, Tanzania, where transmission ranged markedly from 0.03 to 91 infective bites per individual per year. Forty-eight samples, stratified for age and parasite densities, were examined from each village (n = 288). Genotyping was performed by a nested PCR method using primers specific for allele families of genes for the merozoite surface protein 1 (msp-1) and merozoite surface protein 2 (msp-2). A high degree of genetic diversity was found within each village but there were no differences found among the 6 villages. Poisson regressions showed significant effects of host age, village and interaction between host age and village on the complexity of infection. There was a positive, non-linear relationship between complexity of infection and transmission intensity with a maximal number of genotypes found per individual even at high transmission intensities. Furthermore there was a significantly lower complexity found in adults (> 15 years) as compared to children (< 15 years) in the lowland village. This difference was not found as transmission intensity decreased. By comparing data from the same geographical area, using the same methods, and taking into account confounding factors, the present study provides evidence for an effect of both age and transmission intensity on complexity of infection with P. falciparum.

Malaria and anaemia at different altitudes in the Muheza district of Tanzania: childhood morbidity in relation to level of exposure to infection.

Parallel monthly surveys of children aged 6-71 months were conducted in the Muheza district of Tanzania. The aim was to compare highland villages, where the mean, annual entomological inoculation rate (EIR) for malaria is 34 and mean annual prevalences of parasitaemia range from 33%-76%, with culturally similar villages of the lowlands, where the mean EIR is 405 and prevalences of parasitaemia range from 80%-84%. The total survey population could be divided into six geographical subgroups, which can be arranged in order of increasing prevalence of parasitaemia. The prevalences of dense parasitaemia, of febrile malaria, and of anaemia all increased in the same order across this series of groups, the trends being statistically significant. The results of previous studies have indicated a paradoxical effect whereby children in regions with a lower exposure to malarial infection suffer, in the long term, a higher incidence of severe attacks of malaria. In the present study there was no sign of any such paradoxical inverse relationship between the level of exposure and the prevalence of malarial illness or anaemia. However, child mortality rates are similar in the highlands and lowlands, as are the median ages of children admitted to hospital. Overall, the present findings indicate that, for the populations studied, an artificial reduction in EIR would be beneficial, even in the long term, with regard to the chronic effects of malaria. This does not necessarily conflict with previous studies reporting opposite conclusions with regard to the incidence of severe,acute effects.