CO-INFECTION OF PLASMODIUM FALCIPARUM AND EPSTEIN-BARR VIRUS AMONG CHILDREN IN VIHIGA AND KISUMU EAST SUB-COUNTIES, WESTERN KENYA

Abstract

Endemic Burkitt’s lymphoma (eBL) is the most common cancer that affects children in Africa. Co-infection of re-current Plasmodium falciparum (P.falciparum) malaria with Epstein- Barr virus (EBV) is among risk factors of developing eBL. The main objective of the study was to compare the impact of; P. falciparum malaria, EBV and eBL diagnosis, socio-economic factors and malaria control strategies on occurrence and co-occurrence of Plasmodium falciparum malaria and endemic Burkitt’s lymphoma in Vihiga and Kisumu East sub-counties. The specific objectives were; to compare methods used to diagnose Plasmodium falciparum malaria, EBV and eBL in the two sub-counties and to compare impact of age, sex, residence, education, income, size of household, size of land, housing, source of domestic water and vegetation on occurrence and co-occurrence of Plasmodium falciparum malaria and eBL in the two regions. The study also compared malaria control strategies used in reducing occurrence of Plasmodium falciparum malaria and eBL in the sub-counties. From each sub-county, the study assessed thirty homesteads using a questionnaire to collect data on socio-economic factors and malaria control strategies and ten health centers for the case-control study. Chi--square and binary logistic regression were used to compare data variables where p ≤ 0.05 results were considered statistically significant. Results obtained showed that methods used to diagnose Plasmodium falciparum malaria, EBV and eBL in Vihiga and Kisumu East sub-counties were inadequate where P.falciparum and EBV were diagnosed by polymerase chain reaction at KEMRI only. Rapid diagnostic test and microscopy were the main methods used to diagnose P.falciparum in the regions but were not available in all health centers used. EBV and eBL were mainly tested at KEMRI due to lack of facilities in the sub-counties. P. falciparum malaria infection occurred more in children below five years old probably because of their low body immunity. Endemic Burkitt’s lymphoma was more in children aged five to nine years old more likely because of early age co-infection of EBV and re-current Plasmodium falciparum malaria. The diseases were more prevalent in male than female children in both Vihiga and Kisumu East sub-counties. Age had a statistically significant impact on co-occurrence of Plasmodium falciparum malaria and eBL where p-value = 0.004 for Vihiga sub-county and p-value = 0.048 for Kisumu East sub-county. Locations that had low occurrence of Plasmodium falciparum malaria also had low occurrence of eBL because the two diseases are correlated. Socio-economic factors influenced mosquito bites and they impacted only on occurrence of Plasmodium falciparum malaria in Vihiga sub-county. Malaria control strategies used were not well implemented in reducing occurrence of Plasmodium falciparum malaria and eBL in the two sub-counties. Malaria prevention and control programmes should be intensified and evaluated more regularly in the regions and in Kenya.