A review of new challenges and prospects for malaria elimination in Mutare and Mutasa Districts, Zimbabwe

Sande, Shadreck; Zimba, Moses; Chinwada, Peter; Masendu, Hieronymo; Mberikunshe, Joseph; Makuwaza, Aramu

doi:10.1186/s12936-016-1415-2

Cited by 20 publications

(18 citation statements)

References 20 publications

(38 reference statements)

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“…Although the results are in line with several studies that classify malaria as an environmental disease, the pattern also reflect the impact of malaria control interventions in reducing the disease burden. This may be supported by previous studies which showed that although the southern region have suitable environmental conditions for malaria transmission, most districts in this region are in the malaria pre-elimination phase resulting in the observed low prevalence [ 12 , 67 , 68 ].…”

Section: Discussionsupporting

confidence: 70%

Spatial overlaps in the distribution of HIV/AIDS and malaria in Zimbabwe

et al. 2018

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BackgroundIn most developing economies particularly in Africa, more people are likely to die of HIV/AIDS and malaria compared to other diseases. HIV/AIDS tends to be superimposed on the long standing malaria burden particularly in sub-Saharan Africa. The detection and understanding of spatial overlaps in disease occurrence is important for integrated and targeted disease control. Integrated disease control can enhance efficiency and cost-effectiveness through the development of drugs targeting multiple infections in the same geographic space.MethodsUsing Zimbabwe as a case study, this study tests the hypothesis that malaria clusters coincide with HIV/AIDS clusters in space. Case data for the two diseases were obtained from the Ministry of Health and Child Care in Zimbabwe at district level via the District Health Information System (DHIS). Kulldorff’s spatial scan statistic was used to test for spatial overlaps in clusters of high cases of HIV/AIDS and malaria at district level. The spatial scan test was used to identify areas with higher cases of HIV/AIDS and malaria than would be expected under spatial randomness.ResultsResults of this study indicate that primary clusters of HIV/AIDS and malaria were not spatially coincident in Zimbabwe. While no spatial overlaps were detected between primary clusters of the two diseases, spatial overlaps were detected among statistically significant secondary clusters of HIV/AIDS and malaria. Spatial overlaps between HIV/AIDS and malaria occurred in five districts in the northern and eastern regions of Zimbabwe. In addition, findings of this study indicate that HIV/AIDS is more widespread in Zimbabwe compared to malaria.ConclusionsThe results of this study may therefore be used as a basis for spatially-targeted control of HIV/AIDS and malaria particularly in high disease burden areas. This is important as previous interventions have targeted the two diseases separately. Thus, targeted control could assist in resource allocation through prioritising areas in greatest need hence maximising the impact of disease control.

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Section: Discussionsupporting

confidence: 70%

Spatial overlaps in the distribution of HIV/AIDS and malaria in Zimbabwe

et al. 2018

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“…Longitudinal studies in Kenya [ 7 , 8 ], Senegal [ 9 ] and Guinea Bissau [ 10 ] have all demonstrated that the changing epidemiology of infection and disease cannot be easily explained by changing coverage of interventions such as vector control alone. While these studies all demonstrate an overall decline in malaria, in Kenya and Guinea Bissau, resurgent risks were documented after 2012 and this was consistent with resurgent risks during the same period in Zimbabwe [ 11 ] and Mozambique [ 12 , 13 ]. Furthermore, recent reports have also showed a resurgence of malaria in many countries particularly in 2016, whereby malaria cases increased by over 6 million compared to 2015 [ 1 , 2 ].…”

Section: Introductionmentioning

confidence: 58%

Trends of Plasmodium falciparum prevalence in two communities of Muheza district North-eastern Tanzania: correlation between parasite prevalence, malaria interventions and rainfall in the context of re-emergence of malaria after two decades of progressively declining transmission

Ishengoma

Mmbando

Chiduo

et al. 2018

Malar J

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BackgroundAlthough the recent decline of malaria burden in some African countries has been attributed to a scale-up of interventions, such as bed nets (insecticide-treated bed nets, ITNs/long-lasting insecticidal nets, LLINs), the contribution of other factors to these changes has not been rigorously assessed. This study assessed the trends of Plasmodium falciparum prevalence in Magoda (1992–2017) and Mpapayu (1998–2017) villages of Muheza district, North-eastern Tanzania, in relation to changes in the levels of different interventions and rainfall patterns.MethodsIndividuals aged 0–19 years were recruited in cross-sectional surveys to determine the prevalence of P. falciparum infections in relation to different malaria interventions deployed, particularly bed nets and anti-malarial drugs. Trends and patterns of rainfall in Muheza for 35 years (from 1981 to 2016) were assessed to determine changes in the amount and pattern of rainfall and their possible impacts on P. falciparum prevalence besides of those ascribed to interventions.ResultsHigh prevalence (84–54%) was reported between 1992 and 2000 in Magoda, and 1998 and 2000 in Mpapayu, but it declined sharply from 2001 to 2004 (from 52.0 to 25.0%), followed by a progressive decline between 2008 and 2012 (to ≤ 7% in both villages). However, the prevalence increased significantly from 2013 to 2016 reaching ≥ 20.0% in 2016 (both villages), but declined in the two villages to ≤ 13% in 2017. Overall and age specific P. falciparum prevalence decreased in both villages over the years but with a peak prevalence shifting from children aged 5–9 years to those aged 10–19 years from 2008 onwards. Bed net coverage increased from < 4% in 1998 to > 98% in 2001 and was ≥ 85.0% in 2004 in both villages; followed by fluctuations with coverage ranging from 35.0 to ≤ 98% between 2008 and 2017. The 12-month weighted anomaly standardized precipitation index showed a marked rainfall deficit in 1990–1996 and 1999–2010 coinciding with declining prevalence and despite relatively high bed net coverage from 2000. From 1992, the risk of infection decreased steadily up to 2013 when the lowest risk was observed (RR = 0.07; 95% CI 0.06–0.08, P < 0.001), but it was significantly higher during periods with positive rainfall anomalies (RR = 2.79; 95% CI 2.23–3.50, P < 0.001). The risk was lower among individuals not owning bed nets compared to those with nets (RR = 1.35; 95% CI 1.22–1.49, P < 0.001).ConclusionsA decline in prevalence up to 2012 and resurgence thereafter was likely associated with changes in monthly rainfall, offset against changing malaria interventions. A sustained surveillance covering multiple factors needs to be undertaken and climate must be taken into consideration when relating control interventions to malaria prevalence.Electronic supplementary materialThe online version of this article (10.1186/s12936-018-2395-1) contains supplementary material, which is available to authorized users.

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“…Zimbabwe has a long history of vector control, particularly IRS, dating back to the late 1940s, using benzene hexachloride (BHC), dichloro-diphenyl-trichloro-ethane (DDT), and more recently pyrethroids and organophosphates [4, 5]. Historically in Zimbabwe, use of LLINs has had a much lesser role in malaria control interventions compared to IRS until the first mass campaign in 2010 [6].…”

Section: Introductionmentioning

confidence: 99%

Progress towards malaria elimination in Zimbabwe with special reference to the period 2003–2015

Sande¹,

Zimba

Mberikunashe

et al. 2017

Malar J

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BackgroundAn intensive effort to control malaria in Zimbabwe has produced dramatic reductions in the burden of the disease over the past 13 years. The successes have prompted the Zimbabwe’s National Malaria Control Programme to commit to elimination of malaria. It is critical to analyse the changes in the morbidity trends based on surveillance data, and scrutinize reorientation to strategies for elimination.MethodsThis is a retrospective study of available Ministry of Health surveillance data and programme reports, mostly from 2003 to 2015. Malaria epidemiological data were drawn from the National Health Information System database. Data on available resources, malaria control strategies, morbidity and mortality trends were analysed, and opportunities for Zimbabwe malaria elimination agenda was perused.ResultsWith strong government commitment and partner support, the financial gap for malaria programming shrank by 91.4% from about US$13 million in 2012 to US$1 million in 2015. Vector control comprises indoor residual house spraying (IRS) and long-lasting insecticidal nets, and spray coverage increased from 28% in 2003 to 95% in 2015. Population protected by IRS increased also from 20 to 96% for the same period. In 2009, diagnostics improved from clinical to parasitological confirmation either by rapid diagnostic tests or microscopy. Artemisinin-based combination therapy was used to treat malaria following chloroquine resistance in 2000, and sulfadoxine–pyrimethamine in 2004. In 2003, there were 155 malaria cases per 1000 populations reported from all health facilities throughout the country. The following decade witnessed a substantial decline in cases to only 22 per 1000 populations in 2012. A resurgence was reported in 2013 (29/1000) and 2014 (39/1000), thereafter morbidity declined to 29 cases per 1000 populations, only to the same level as in 2013. Overall, morbidity declined by 81% from 2003 to 2015. Inpatient malaria deaths per 100,000 populations doubled in 4 years, from 2/100,000 to 4/100,000 populations in 2012–2015 respectively. Twenty of the 47 moderate to high burdened districts were upgraded from control to malaria pre-elimination between 2012 and 2015.ConclusionsA significant progress to reduce malaria transmission in Zimbabwe has been made. While a great potential and opportunities to eliminate malaria in the country exist, elimination is not a business as usual approach. Instead, it needs an improved, systematic and new programmatic strategy supported strongly by political will, sustained funding, good leadership, community engagement, and a strong monitoring and evaluation system all year round until the cessation of local transmission.

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A review of new challenges and prospects for malaria elimination in Mutare and Mutasa Districts, Zimbabwe

Cited by 20 publications

References 20 publications

Spatial overlaps in the distribution of HIV/AIDS and malaria in Zimbabwe

Spatial overlaps in the distribution of HIV/AIDS and malaria in Zimbabwe

Trends of Plasmodium falciparum prevalence in two communities of Muheza district North-eastern Tanzania: correlation between parasite prevalence, malaria interventions and rainfall in the context of re-emergence of malaria after two decades of progressively declining transmission

Progress towards malaria elimination in Zimbabwe with special reference to the period 2003–2015

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