Effect of anti-malarial interventions on trends of malaria cases, hospital admissions and deaths, 2005–2015, Ghana

Abstract

BackgroundSince 2005, the Government of Ghana and its partners, in concerted efforts to control malaria, scaled up the use of artemisinin-based combination therapy (ACT) and insecticide-treated nets (ITNs). Beginning in 2011, a mass campaign of long-lasting insecticidal nets (LLINs) was implemented, targeting all the population. The impact of these interventions on malaria cases, admissions and deaths was assessed using data from district hospitals.MethodsRecords of malaria cases and deaths and availability of ACT in 88 hospitals, as well as at district level, ITN distribution, and indoor residual spraying were reviewed. Annual proportion of the population potentially protected by ITNs was estimated with the assumption that each LLIN covered 1.8 persons for 3 years. Changes in trends of cases and deaths in 2015 were estimated by segmented log-linear regression, comparing trends in post-scale-up (2011–2015) with that of pre-scale-up (2005–2010) period. Trends of mortality in children under 5 years old from population-based household surveys were also compared with the trends observed in hospitals for the same time period.ResultsAmong all ages, the number of outpatient malaria cases (confirmed and presumed) declined by 57% (95% confidence interval [CI], 47–66%) by first half of 2015 (during the post-scale-up) compared to the pre-scale-up (2005–2010) period. The number of microscopically confirmed cases decreased by 53% (28–69%) while microscopic testing was stable. Test positivity rate (TPR) decreased by 41% (19–57%). The change in malaria admissions was insignificant while malaria deaths fell significantly by 65% (52–75%). In children under 5 years old, total malaria outpatient cases, admissions and deaths decreased by 50% (32–63%), 46% (19–75%) and 70% (49–82%), respectively. The proportion of outpatient malaria cases, admissions and deaths of all-cause conditions in both all ages and children under five also fell significantly by >30%. Similar decreases in the main malaria indicators were observed in the three epidemiological strata (coastal, forest, savannah). All-cause admissions increased significantly in patients covered by the National Health Insurance Scheme (NHIS) compared to the non-insured. The non-malaria cases and non-malaria deaths increased or remained unchanged during the same period. All-cause mortality for children under 5 years old in household surveys, similar to those observed in the hospitals, declined by 43% between 2008 and 2014.ConclusionsThe data provide compelling evidence of impact following LLIN mass campaigns targeting all ages since 2011, while maintaining other anti-malarial interventions. Malaria cases and deaths decreased by over 50 and 65%, respectively. The declines were stronger in children under five. Test positivity rate in all ages decreased by >40%. The decrease in malaria deaths was against a backdrop of increased admissions owing to free access to hospitalization through the NHIS. The study demonstrated that retrospective health facility-based data minimize reporting bias...

Repeated mosquito net distributions, improved treatment, and trends in malaria cases in sentinel health facilities in Papua New Guinea

“…While multiple studies demonstrated the effect of LLIN programmes on P. falciparum incidence (e.g. [25,26]), evidence from settings with several Plasmodium species is scarce. Although it has been suggested that the impact of vector control on P. vivax may be delayed due to the parasite's biology, this study only found short-term transient increases in the proportion of P. vivax by light microscopy, suggesting that at intermediate to high transmission, both species are affected by vector control and both species may resurge.…”

Accounting for regional transmission variability and the impact of malaria control interventions in Ghana: A population level mathematical modelling approach

“…The gradual improvement in the data capture and reporting, through the DHIMS infrastructure, at the district level in government health facilities and faith based private facilities across the country were accounted for by allowing for various levels of reporting and system improvements from 2008 to 2018. Years of improvement in all suspected cases receiving a malaria diagnostic test was also incorporated (Fig 3) [59,60].…”

“…The roll out of LLINs on a large scale basis in Ghana begun from 2003 [59]. This resulted in a substantial improvement in the proportion of households with at least one LLIN as well as at least one LLIN per every two members of a household (universal coverage) across the country [52].…”

“…However, relative to LLINs, the coverage of IRS is by far the lowest across the country. Although parts of the Guinea savannah and the Transitional forest zones have had some implementation of IRS on pilot bases, studies are yet to be sited of any such activities rolled out in the Coastal savannah [59,66,67].…”

Accounting for regional transmission variability and the impact of malaria control interventions in Ghana: A population level mathematical modelling approach.

“…Differences in transmission potential for young children, adults and pregnant women were also considered. The gradual improvement in the data capture and reporting, through the DHIMS infrastructure, at the district level in government health facilities, faith based private facilities across the country were accounted for by allowing for various levels of reporting and system improvements from 2008 to 2018 while years of improvement of malaria diagnosis was also incorporated [21,22].…”