"Familiar Foe Revisited": examining the relationship between endemic Burkitt's lymphoma and changing malaria admissions in the coastal region of Kenya.

BACKGROUND: Burkitt’s lymphoma (BL) is a type of non-Hodgkin lymphoma that may account for more than 40% of childhood malignancies in tropical Africa. The endemic version is common in equatorial Africa, where a BL belt has been mapped. The role of P. falciparum malaria infection in BL has been postulated but not substantiated. The decrease in P. falciparum malaria infection offers an opportunity to examine this association. METHODS: In this study, we utilized data collected over three decades (1990–2020) and examined the trends in annual admission incidence rates of Burkitt’s lymphoma among pediatric admissions (0–14 years) in relation to the reduction in malaria admissions. FINDINGS: Ninety-five patients with Burkitt’s lymphoma were identified, of whom 72 (75.8%) were male. During the first epoch (1990–1999) and second decade, 29 cases and 62 cases were diagnosed, resulting in 10-year cumulative incidence rates of 93.1 cases and 130.3 cases per 100,000, respectively. In the third decade, 2010–2020, there were only 4 cases (cumulative incidence of 10.2 cases per 100,000). With one-way ANOVA, the F statistic for within- and between-group comparisons was significant (p < 0.0001), indicating that the decline across the three epochs was statistically significant. Similarly, the median parasite density decreased from 13,966 (Q1:2090, Q3:126,000) in the first epoch to 7,224 (Q1:1566, Q3:109,200) in the third epoch (Kruskal‒Wallis chi-square test, 12.3; P = 0.0021). One-way ANOVA for within- and between-group comparisons was equally significant (p < 0.001). The correlation coefficient between endemic BL and P. falciparum malaria infection was 0.53, indicating a strong positive correlation (P = 0.0024), implying that as P. falciparum malaria infection decreased, the endemic BL incidence rate decreased. INTERPRETATION: There has been a significant reduction in the annual incidence rates of Burkitt’s lymphoma in the coastal region of Kenya. It is plausible that this decrease can be explained by an equally sustained and significant decline in the number of falciparum malaria infections.