Endemic Burkitt lymphoma (eBL) is the most common childhood cancer in sub-Saharan African countries, however, few epidemiologic studies have been undertaken and none attempted enrolling cases from multiple countries. We therefore conducted a population-based case-control study of eBL in children aged 0–15 years old in six regions in Northern Uganda, Northern Tanzania, and Western Kenya, enrolling 862 suspected cases and 2,934 population-controls (response rates 98.5–100%), and processing ~40,000 vials of samples using standardized protocols. Risk-factor questionnaires were administered, and malaria period prevalence was measured using rapid diagnostic tests (RDTs). A total of 80.9% of the recruited cases were diagnosed as eBL; 61.4% confirmed by histology. Associations with eBL risk were computed using logistic regression models adjusted for relevant confounders. Associations common in at least two countries were emphasized. eBL risk was decreased with higher maternal income and paternal education and elevated with history of inpatient malaria treatment >12 months before enrollment, and with HIV seropositivity. Reporting malaria-attributed fever up to 6 months before enrollment and malaria-RDT positivity at enrollment were associated with decreased eBL risk. Conversely, reporting exposure to mass malaria suppression programs (e.g., indoor residual insecticide) was associated with elevated risk. HIV was associated with elevated eBL risk. The study shows that it is feasible to conduct networked, multisite population-based studies of eBL in Africa. eBL was inversely associated with socioeconomic status, positively associated with inpatient malaria treatment 12 months ago and with living in areas tageted for malaria suppression, which support a role of malaria in eBL.
【저자키워드】 HIV/AIDS, Epidemiology, Epstein-Barr virus, Non-Hodgkin Lymphoma, Burkitt lymphoma, Plasmodium falciparum malaria,