Send to

Choose Destination
Int J Cancer. 2019 May 4. doi: 10.1002/ijc.32390. [Epub ahead of print]

Risk factors for Burkitt lymphoma in East African children and minors: A case-control study in malaria-endemic regions in Uganda, Tanzania and Kenya.

Author information

Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD.
EMBLEM Study, St. Mary's Hospital Lacor, Gulu, Uganda.
African Field Epidemiology Network, Kampala, Uganda.
EMBLEM Study, Kuluva Hospital Kuluva, Arua, Uganda.
Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD.
EMBLEM Study, Moi University College of Health Sciences, Eldoret, Kenya.
EMBLEM Study, Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya.
Kenya Medical Research Institute, Kisumu, Kenya.
EMBLEM Study, Bugando Medical Center, Mwanza, Tanzania.
EMBLEM Study, Shirati Health and Educational Foundation, Shirati, Tanzania.
Department of Pathology, The Ohio State University, Columbus, OH.


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. 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 seropositivity was associated with elevated eBL risk, but the relative impact was small. 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 targeted for malaria suppression, which support a role of malaria in eBL.


Burkitt lymphoma; Epstein-Barr virus; HIV/AIDS; Plasmodium falciparum malaria; epidemiology; non-Hodgkin lymphoma

[Available on 2020-11-04]

Supplemental Content

Full text links

Icon for Wiley
Loading ...
Support Center