Impact of Artemisinin-Based Combination Therapy and Insecticide-Treated Nets on Malaria Burden in Zanzibar

Abstract

BackgroundThe Roll Back Malaria strategy recommends a combination of interventions for malaria control. Zanzibar implemented artemisinin-based combination therapy (ACT) for uncomplicated malaria in late 2003 and long-lasting insecticidal nets (LLINs) from early 2006. ACT is provided free of charge to all malaria patients, while LLINs are distributed free to children under age 5 y (“under five”) and pregnant women. We investigated temporal trends in Plasmodium falciparum prevalence and malaria-related health parameters following the implementation of these two malaria control interventions in Zanzibar.Methods and FindingsCross-sectional clinical and parasitological surveys in children under the age of 14 y were conducted in North A District in May 2003, 2005, and 2006. Survey data were analyzed in a logistic regression model and adjusted for complex sampling design and potential confounders. Records from all 13 public health facilities in North A District were analyzed for malaria-related outpatient visits and admissions. Mortality and demographic data were obtained from District Commissioner's Office. P. falciparum prevalence decreased in children under five between 2003 and 2006; using 2003 as the reference year, odds ratios (ORs) and 95% confidence intervals (CIs) were, for 2005, 0.55 (0.28–1.08), and for 2006, 0.03 (0.00–0.27); p for trend < 0.001. Between 2002 and 2005 crude under-five, infant (under age 1 y), and child (aged 1–4 y) mortality decreased by 52%, 33%, and 71%, respectively. Similarly, malaria-related admissions, blood transfusions, and malaria-attributed mortality decreased significantly by 77%, 67% and 75%, respectively, between 2002 and 2005 in children under five. Climatic conditions favorable for malaria transmission persisted throughout the observational period.ConclusionsFollowing deployment of ACT in Zanzibar 2003, malaria-associated morbidity and mortality decreased dramatically within two years. Additional distribution of LLINs in early 2006 resulted in a 10-fold reduction of malaria parasite prevalence. The results indicate that the Millennium Development Goals of reducing mortality in children under five and alleviating the burden of malaria are achievable in tropical Africa with high coverage of combined malaria control interventions.

International population movements and regional Plasmodium falciparum malaria elimination strategies

“…eradication | migration | network analysis | imported malaria | community detection S ignificant progress is being made in reducing the morbidity and mortality attributed to malaria globally (1)(2)(3)(4)(5)(6)(7)(8)(9)(10), encouraging the Global Malaria Action Plan (GMAP) (11) to articulate a long-term vision for malaria eradication through shorter-term local efforts to eliminate malaria. A total of 34 of the 107 malaria endemic countries have declared they have a national policy for malaria elimination or are pursuing spatially progressive elimination within their borders (11)(12)(13).…”

The heart of translation

“…Similarly, pregnant women A recent study in Zanzibar showed that, following deployment of antimalarial combined therapy, malariaassociated morbidity and mortality decreased dramatically: crude under-five mortality decreased by 52% while infant and child mortality declined by 33% and 71%, respectively. 10 Similarly, in Eritrea, following implementation of multiple intervention coverage, malaria morbidity and case fatality fell by 84% and 40%, respectively.…”

Malaria: Control, Elimination, and Eradication

“…8 In the past few years, African countries, such as Tanzania, Sao Tome and Principe, Eritrea, and Rwanda, where malaria is endemic, have provided high-risk populations with effective mosquito control intervention and access to artemisinin-based combination therapies (ACTs). [9][10][11] Additionally, small elimination campaigns utilizing frequent insecticide spraying in houses and rounds of mass treatment were undertaken in Nigeria, under the auspices of the Garki project 12 and on the Kenyan/Tanzanian border, termed the Pare-Taveta project. 8,13 These projects entailed the combination of frequent insecticide spraying in houses to reduce vector populations and mass treatment to reduce the human infectious reservoir.…”