The epidemiology, surveillance and control of malaria in Kenyan school children

School-aged children are the age group least protected by malaria interventions such as bed nets, despite being the age group most likely to be infected with malaria parasites. Effective targeting of malaria interventions among this age group is hampered by the lack of detailed data on the epidemiology of malaria. This thesis aims to describe the epidemiology of malaria among school children in Kenya and explores the usefulness of school-based approaches in malaria surveillance and control. A nationwide school malaria survey was carried across the different malaria ecologies in Kenya. These data allowed analysis in different settings of risk factors for Plasmodium infection and anaemia and the evaluation of alternate malaria diagnostic methods. A cluster randomised trial was conducted in coastal Kenya to evaluate the effectiveness of school-based distribution of mosquito nets. Finally, the congruence between reports of net use from school and household surveys was evaluated. Prevalence of Plasmodium infection was low overall, but varied markedly across the country. Risk factors for Plasmodium infection and anaemia varied by malaria transmission zone, with net use associated with reduced odds of infection in only coastal and western highland epidemic zones. The school-based distribution of mosquito nets was associated with an increase in reported net use but had no impact on Plasmodium infection or anaemia. In terms of identifying infection among individuals and populations, malaria rapid diagnostic tests represent a cheap diagnostic approach, especially in low and high prevalence settings. School surveys can also provide a reliable estimate of net use among both school children and households. Collectively, these results highlight the burden of malaria among Kenyan school children but show how this burden varies by transmission setting, emphasizing the need for a geographically targeted approach to tackling malaria. The results also demonstrate the role that schools can play in the surveillance and control of malaria.