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Large-scale malaria survey in Cambodia: Novel insights on species distribution and risk factors

Sandra Incardona1, Sirenda Vong2, Lim Chiv3, Pharath Lim1, Sina Nhem3, Rithy Sem3, Nimol Khim1, Socheat Doung3, Odile Mercereau-Puijalon4 and Thierry Fandeur14*

Author Affiliations

1 Laboratory of Molecular Epidemiology, Institut Pasteur du Cambodge, Phnom Penh, Cambodia

2 Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia

3 National Centre for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia

4 Unité d'Immunologie Moléculaire des Parasites, Institut Pasteur, 28 rue du Dr Roux, 75724 PARIS cedex 15, France

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Malaria Journal 2007, 6:37  doi:10.1186/1475-2875-6-37

Published: 27 March 2007

Abstract

Background

In Cambodia, estimates of the malaria burden rely on a public health information system that does not record cases occurring among remote populations, neither malaria cases treated in the private sector nor asymptomatic carriers. A global estimate of the current malaria situation and associated risk factors is, therefore, still lacking.

Methods

A large cross-sectional survey was carried out in three areas of multidrug resistant malaria in Cambodia, enrolling 11,652 individuals. Fever and splenomegaly were recorded. Malaria prevalence, parasite densities and spatial distribution of infection were determined to identify parasitological profiles and the associated risk factors useful for improving malaria control programmes in the country.

Results

Malaria prevalence was 3.0%, 7.0% and 12.3% in Sampovloun, Koh Kong and Preah Vihear areas. Prevalences and Plasmodium species were heterogeneously distributed, with higher Plasmodium vivax rates in areas of low transmission. Malaria-attributable fevers accounted only for 10–33% of malaria cases, and 23–33% of parasite carriers were febrile. Multivariate multilevel regression analysis identified adults and males, mostly involved in forest activities, as high risk groups in Sampovloun, with additional risks for children in forest-fringe villages in the other areas along with an increased risk with distance from health facilities.

Conclusion

These observations point to a more complex malaria situation than suspected from official reports. A large asymptomatic reservoir was observed. The rates of P. vivax infections were higher than recorded in several areas. In remote areas, malaria prevalence was high. This indicates that additional health facilities should be implemented in areas at higher risk, such as remote rural and forested parts of the country, which are not adequately served by health services. Precise malaria risk mapping all over the country is needed to assess the extensive geographical heterogeneity of malaria endemicity and risk populations, so that current malaria control measures can be reinforced accordingly.