Infectious Disease
Household Clustering of Malaria, Pneumonia, and Diarrhea Cases: Exploring Co-occurrence Patterns Annika Gunderson* Annika Gunderson Abel Bwambale Emmanuel Baguma Varun Goel Moses Ntaro Edgar M. Mulogo Ross M. Boyce
Introduction: Malaria, pneumonia, and diarrhea are important causes of mortality among children <5 years of age in Uganda. Although low socioeconomic status is a common risk factor, less is known about potential intersecting risk between these diseases at the household level.
Methods: A prospective cohort study was conducted in three villages in rural Western Uganda. Following baseline surveys to assess demographic and household characteristics, and malaria prevention and care seeking, we performed 7 months of clinical surveillance at neighboring health centers. Logistic regression models were fit for malaria, pneumonia, and diarrhea separately including terms for the other two diseases. We then compared characteristics among households with co-occurrences of malaria and pneumonia using Fisher’s exact tests.
Results: Among the 324 households included in this analysis, there were 29 cases of malaria and pneumonia occurring within rolling four-week periods. Notably, 26 (90%) of these episodes occurred among 11 households in one village, Kasanzi. We found significant associations with pneumonia cases in households with malaria infections (aOR: 1.30 (95% CI: (1.086, 1.560) and the malaria cases in households with pneumonia infections (aOR: 2.33 (95% CI: 0.969, 5.492). Village was highly significant (p-value: <0.001) and socioeconomic status was marginally significant with co-occurrence of the two diseases (p-value: 0.098) within the high incidence village. Cases of diarrhea did not appear to be associated with cases of either malaria or pneumonia.
Conclusion: Malaria and pneumonia appear to cluster in specific households and villages. This may be due to shared risk factors or care seeking patterns for respiratory illness that identify asymptomatic parasitemia. Understanding overlap in disease occurrence allows for integrated disease control and treatment measures for households with a double burden of disease.