Pediatr Blood Cancer. 2022 Jun 22:e29867. doi: 10.1002/pbc.29867. Online ahead of print.
BACKGROUND: Burkitt lymphoma (BL) accounts for 90% of pediatric lymphomas in sub-saharan Africa. Plasmodium falciparum (Pf) malaria is considered an etiological factor of BL. We describe the geographic distribution of pediatric BL in Malawi and association with malaria prevalence (PfPR).
METHODS: We enrolled 220 pathologically confirmed incident pediatric BL cases (2013-2018) into an observational clinical cohort at Kamuzu Central Hospital (KCH) in Lilongwe district. KCH is the main tertiary cancer referral center serving the central and northern region of Malawi. Using an ecological study design, we calculated district-level annual BL incidence rate using census population estimates. District-level PfPR was extracted from the National Malaria Control Program 2010 report. BL incidence and PfPR maps were constructed in QGIS. Moran’s I was used to identify BL spatial clusters. Pearson’s correlation and multiple linear regression was used to statistically examine the relationship between PfPR and BL.
RESULTS: BL incidence was higher in central region districts (8.2 cases per million) than northern districts (2.9 cases per million) and was elevated in lakeshore districts. Districts with elevated PfPR tended to have elevated BL incidence. A low-risk BL cluster was detected in the north. Statistically, BL incidence was positively correlated with PfPR (r = 0.77, p<0.01). A 1% increase in PfPR predicted an increase in BL incidence of 0.2 cases per million (p = 0.03) when controlling for travel time from referral district hospital to KCH.
CONCLUSION: Our study supports evidence for an association between Pf and BL and highlights a need to improve geographic accessibility to tertiary cancer services in Malawi’s northern region. This article is protected by copyright. All rights reserved.