{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T03:32:38Z","timestamp":1791084758981,"version":"4.1.0"},"reference-count":30,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2006,10,3]],"date-time":"2006-10-03T00:00:00Z","timestamp":1159833600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Intl Journal of Cancer"],"published-print":{"date-parts":[[2007,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Endemic Burkitt's lymphoma (eBL), the most common childhood cancer in sub\u2010Saharan Africa, occurs at a high incidence in western Kenya, a region that also experiences holoendemic malaria. Holoendemic malaria has been identified as a co\u2010factor in the etiology of this cancer. We hypothesized that eBL may cluster spatially within this region. Medical records for all eBL cases diagnosed from 1999 through 2004 at Nyanza Provincial General Hospital were reviewed for case residential information to examine this hypothesis. Two cluster detection methods, Anselin's Local Moran test for spatial autocorrelation and a spatial scan test statistic, were applied to this residential data to determine whether statistically significant high\u2010 and low\u2010risk areas were present in the Province. During the 6\u2010year study period, 272 children were diagnosed with eBL, with an average annual incidence of 2.15 cases per 100,000 children. Using Empirical Bayes smoothed rates, the Local Moran test identified 1 large multi\u2010centered area of low eBL risk (<jats:italic>p<\/jats:italic>\u2010values &lt; 0.01) and 2 significant multi\u2010centered clusters of high eBL risk (<jats:italic>p<\/jats:italic>\u2010values &lt; 0.001). The spatial scan detected 3 small independent low\u2010risk areas (<jats:italic>p<\/jats:italic>\u2010values &lt; 0.02) and 2 high\u2010risk clusters (<jats:italic>p<\/jats:italic>\u2010values = 0.001), both similar in location to those identified from the Local Moran analysis. Significant spatial clustering of elevated eBL risk in high\u2010malaria transmission regions and of reduced incidence where malaria is infrequent suggests that malaria plays a role in the complex eBL etiology, but that additional factors are also likely involved. \u00a9 2006 Wiley\u2010Liss, Inc.<\/jats:p>","DOI":"10.1002\/ijc.22179","type":"journal-article","created":{"date-parts":[[2006,10,3]],"date-time":"2006-10-03T18:58:08Z","timestamp":1159901888000},"page":"121-127","source":"Crossref","is-referenced-by-count":73,"title":["Spatial clustering of endemic Burkitt's lymphoma in high\u2010risk regions of Kenya"],"prefix":"10.1002","volume":"120","author":[{"given":"Jeanette J.","family":"Rainey","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorine","family":"Omenah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter O.","family":"Sumba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann M.","family":"Moormann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosemary","family":"Rochford","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark L.","family":"Wilson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2006,10,3]]},"reference":[{"key":"e_1_2_6_2_2","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.1962.43"},{"key":"e_1_2_6_3_2","first-page":"429","article-title":"An improved map for the study of Burkitt's lymphoma","volume":"40","author":"Haddow AJ","year":"1963","journal-title":"East Afr Med J"},{"key":"e_1_2_6_4_2","first-page":"19","article-title":"Etiology of Burkitt's lymphoma\u2010an alternative hypothesis to a vectored virus","volume":"42","author":"Burkitt D","year":"1969","journal-title":"J Natl Cancer Inst"},{"key":"e_1_2_6_5_2","first-page":"197","article-title":"Epidemiology of Burkitt's lymphoma: other risk factors","volume":"60","author":"Evans AS","year":"1985","journal-title":"IARC Sci Publ"},{"key":"e_1_2_6_6_2","first-page":"97","article-title":"Epidemiological evidence for the role of falciparum malaria in the pathogenesis of Burkitt's lymphoma","volume":"60","author":"Morrow RH","year":"1985","journal-title":"IARC Sci Publ"},{"key":"e_1_2_6_7_2","first-page":"253","article-title":"Clustering of Burkitt's lymphoma and other high\u2010grade malignant lymphoproliferative diseases, but not acute lymphoblastic leukaemia among socio\u2010economically deprived Nigerians","volume":"65","author":"Williams CK","year":"1988","journal-title":"East Afr Med J"},{"key":"e_1_2_6_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0035-9203(00)90240-2"},{"key":"e_1_2_6_9_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.2.5549.395"},{"key":"e_1_2_6_10_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.2.5760.491"},{"key":"e_1_2_6_11_2","first-page":"1875","article-title":"Time\u2010space case clusters of Burkitt's lymphoma in Malawi","volume":"7","author":"van den Bosch C","year":"1993","journal-title":"Leukemia"},{"key":"e_1_2_6_12_2","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.2910230310"},{"key":"e_1_2_6_13_2","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.1973.175"},{"key":"e_1_2_6_14_2","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.2910250206"},{"key":"e_1_2_6_15_2","doi-asserted-by":"crossref","first-page":"343","DOI":"10.4269\/ajtmh.1996.54.343","article-title":"The pattern of pediatric solid malignant tumors in western Kenya, east Africa, 1979\u20131994: an analysis based on histopathologic study","volume":"54","author":"Makata AM","year":"1996","journal-title":"Am J Trop Med Hyg"},{"key":"e_1_2_6_16_2","first-page":"S68","article-title":"Burkitt's lymphoma in Kenya: geographical, age, gender and ethnic distribution","volume":"8","author":"Mwanda OW","year":"2004","journal-title":"East Afr Med J"},{"key":"e_1_2_6_17_2","unstructured":"Kenya Ministry of Planning and National Development Central Bureau of Statistics.The 1999 Kenya population census. 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