Changes in the burden of malaria following scale up of malaria control interventions in Mutasa District, Zimbabwe

Abstract

BackgroundTo better understand trends in the burden of malaria and their temporal relationship to control activities, a survey was conducted to assess reported cases of malaria and malaria control activities in Mutasa District, Zimbabwe.MethodsData on reported malaria cases were abstracted from available records at all three district hospitals, three rural hospitals and 25 rural health clinics in Mutasa District from 2003 to 2011.ResultsMalaria control interventions were scaled up through the support of the Roll Back Malaria Partnership, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and The President’s Malaria Initiative. The recommended first-line treatment regimen changed from chloroquine or a combination of chloroquine plus sulphadoxine/pyrimethamine to artemisinin-based combination therapy, the latter adopted by 70%, 95% and 100% of health clinics by 2008, 2009 and 2010, respectively. Diagnostic capacity improved, with rapid diagnostic tests (RDTs) available in all health clinics by 2008. Vector control consisted of indoor residual spraying and distribution of long-lasting insecticidal nets. The number of reported malaria cases initially increased from levels in 2003 to a peak in 2008 but then declined 39% from 2008 to 2010. The proportion of suspected cases of malaria in older children and adults remained high, ranging from 75% to 80%. From 2008 to 2010, the number of RDT positive cases of malaria decreased 35% but the decrease was greater for children younger than five years of age (60%) compared to older children and adults (26%).ConclusionsThe burden of malaria in Mutasa District decreased following the scale up of malaria control interventions. However, the persistent high number of cases in older children and adults highlights the need for strategies to identify locally effective control measures that target all age groups.

Prevalence and Factors Associated with Anemia Among Children Under 5 Years of Age—Uganda, 2009

“…Although the UMIS was the first national survey to assess malaria prevalence in Uganda, the prevalence of malaria likely decreased during this interim given the rapid scaleup of malaria control activities. 39 However, we found the prevalence of malaria, as determined by Paracheck-pf RDT, among children under 5 years was still nearly 50% in this study. Although the scale-up of malaria control efforts, are likely responsible in part for the observed concomitant downward trend in anemia prevalence in Uganda, such public health endeavors are unlikely to be sufficient to reduce the burden of anemia in Uganda.…”

Synergistic and antagonistic interactions between bednets and vaccines in the control of malaria

“…In financial terms, morbidity in our model can be directly reflected by the disability-adjusted life years (62); this is a measure of overall disease burden summarizing morbidity and mortality caused by clinical malaria, and expressing the number of years lost due to ill health, disability, or early death. Our findings highlight the importance of monitoring the effects of intervention across all age classes, and not only on young children (50).…”

“…Specifically for Pf, peak prevalence of the parasite shifts to younger age groups as transmission intensity increases (10,11,40), whereas morbidity in the overall host population shifts to older age classes in areas of low-to-moderate transmission (10,49). This outcome is relevant for control because it delineates the groups that are most at risk from clinical disease (35,50); it also implies that reductions of transmission intensity through any form of control will lead to age-dependent shifts in malaria morbidity, from the young children to the older age classes (45,51,52). A major concern is that such age shifts caused by reductions in immunity at the population level may also reflect individual loss of immunity, implying that susceptibility of older hosts to severe disease is increasing (53).…”

“…Despite remarkable success in reducing malaria burdens between 2000 and 2010 through the use of treated bednets (12)(13)(14), the epidemiology of malaria in these settings has also become more complex (50,(58)(59)(60), which is likely reflective of transient dynamics of immunity (61). Notably, in many of the Sub-Saharan African countries, trajectories of adult and child mortality have been following seemingly unrelated trends over the past decade, with increasing ratios of adult to child morbidity, as illustrated in SI Appendix, section VI.…”

Spectrum of Musculoskeletal Tumours in Children in a Tertiary Hospital in Nigeria

“…related illnesses such as malaria and tuberculosis (13)(14)(15)(16) attention to conditions such as tumours tends to take the backstage. The management of tumours also require a multidisciplinary and multimodal approach, (17)(18)(19)(20) the use of specialized diagnostic equipment both laboratory and imaging and a range of treatment modalities, (5,(21)(22)(23)(24) and this further adds to the cost of care, which further limits the quality of care obtainable in resource poor settings.…”