Malaria Mortality and Morbidity in the First Five Years of Life in a Birth Cohort of Children in Northern Ghana

Principal Investigator         : Dr. Abraham Oduro

Collaborators                        : Navrongo Health Research Centre, Noguchi Memorial Institute for Medical Research and the Naval Medical Research Center, USA

Funding                                  : National Institute of Allergy and Infectious Diseases (NIAID/NIH), USA

Project Summary

In areas of intense malaria transmission the greatest burden of malaria morbidity and mortality falls on young children. By age 5 years, children that have survived have developed substantial clinical immunity to malaria and are at much reduced risk of severe morbidity or mortality. Many aspects of malaria epidemiology and immunology important for the development and testing of candidate malaria vaccines can best be studied in long-term cohort studies that follow a birth cohort of children through the entire 5 year period of greatest risk from malaria morbidity and mortality. 

We are therefore conducting a prospective birth cohort study of clinical outcomes related to malaria and collect data on these outcomes to address several immunological and epidemiological questions important to the development and testing of malaria vaccines in KND.  We will measure the incidence density of potential malaria vaccine trial endpoints, including clinical malaria episodes, severe malaria and malaria mortality in the cohort. As the cohort ages, we measure the incidence of key vaccine trial endpoints as a function of age and transmission season. This detailed information on the malaria morbidity experienced by individuals will increase our ability to detect associations between host genetic and immunological factors associated with resistance to malaria morbidity and mortality compared with our previous short-term studies.

We will enrol a cohort of 2000 newborn infants over the course of 12-18 months. We will collect cord blood at birth and finger or heel prick blood samples at the beginning of each annual low transmission and high transmission season from the participants. We will measure antibody levels to a series of proposed candidate vaccine antigens and allele frequencies for a series of candidate disease susceptibility markers. We will follow the children between twice annual visits using passive surveillance and will measure the number of episodes of clinical malaria, severe malaria, and severe malarial anaemia each child experiences.

We will report incidence densities of the clinical outcomes and descriptive statistics for the cumulative malaria experience of each subject over the five-year observation period. We will determine whether antibody levels to any of the candidate antigens are associated with reduced frequency of clinical malaria episodes. We will identify associations between specific host genotypes and resistance or susceptibility to malaria morbidity. Finally, we will use blood samples obtained at the time of clinical episodes to genotype parasite strains circulating in the KND and to assess the nature and extent of allelic variation in candidate malaria vaccine antigens.

Ethics approval has been obtained from

The NHRC-Institutional Review Board and GHS-Ethical Review Committee.

Person to whom correspondence should be addressed:

Dr. Abraham Oduro

Navrongo Health Research Centre

Ministry of Health

PO Box 114

Navrongo, Ghana,

Phone: +233 74 22310, Fax: +233 742 22320

         aoduro@navrongo.mimcom.net