Initial evidence of reduction of malaria cases and deaths in Rwanda and Ethiopia due to rapid scale-up of malaria prevention and treatment

Otten, Mac W.; Aregawi, Maru; Were, Wilson; Karema, Corine; Medin, Ambachew; Bekele, Worku; Jima, Daddi; Gausi, Khoti; Komatsu, Ryuichi; Korenromp, Eline L.; Low‐Beer, Daniel; Grabowsky, Mark

doi:10.1186/1475-2875-8-14

Cited by 197 publications

(176 citation statements)

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“…Similar observations have also been reported from West Bengal during the post-ACT implementation period (http://www.nvbdcp.gov.in/Doc/mal_situation_ Apr2015.pdf) and other malaria-endemic countries (3)(4)(5). Several workers reported a decrease in P. vivax cases whose treatment remained unchanged (CQ ＋ PQ) in areas receiving ACT for P. falciparum only (6).…”

Section: Discussionsupporting

confidence: 72%

“…Artemisinin-based combination therapy (ACT), a combination of artesunate ＋ sulfadoxine-pyrimethamine (AS ＋ SP), was introduced in 2010 as a first-line agent to treat uncomplicated falciparum cases, but chloroquine (CQ) remains the drug of choice for vivax malaria. The introduction of ACT in different countries was associated with a decline in the incidence of falciparum malaria in successive years (3)(4)(5). Such data from India are scarce (6).…”

Section: Discussionmentioning

confidence: 99%

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Impact of Artemisinin-Based Combination Therapy on Falciparum Malaria in Urban Kolkata: A Clinic-Based Report

et al. 2015

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SUMMARY:In India, artemisinin-based combination therapy (ACT; specifically artesunate ＋ sulfadoxine-pyrimethamine) has been implemented for uncomplicated falciparum malaria since 2010. But for vivax malaria drug policy remained unchanged i.e., chloroqine and primaquine. We observed the impact of this intervention in urban Kolkata by analyzing data from the Malaria Clinic from 2001 to 2013. In Kolkata, we observed that Plasmodium vivax was perennial, whereas P. falciparum infection was seasonal. Before ACT implementation, the proportion of P. falciparum was as high as 50z and it steadily decreased during 4 successive years post intervention. No change was observed in the number of P. vivax cases. ACT may be an effective measure in reducing falciparum malaria cases. Artemisininderivative combination therapies should be explored in vivax malaria to reduce the overall burden of malaria.A total of 207 million diagnosed cases of malaria and 627,000 deaths globally were reported in 2012 (http:// www.who.int/malaria/publications/world _ malaria _ report_2013/en/). Approximately one-third of the world's population at risk for malaria lives in India, where Plasmodium falciparum accounts for about 50z of the total malaria cases (1). Since 2005, the National Vector Borne Disease Control Programme (NVBDCP) of India has introduced new interventions and undertaken several policy changes to improve malaria control (2). Artemisinin-based combination therapy (ACT), a combination of artesunate ＋ sulfadoxine-pyrimethamine (AS ＋ SP), was introduced in 2010 as a first-line agent to treat uncomplicated falciparum cases, but chloroquine (CQ) remains the drug of choice for vivax malaria. The introduction of ACT in different countries was associated with a decline in the incidence of falciparum malaria in successive years (3-5). Such data from India are scarce (6). The present report focuses on the impact of ACT on the total number of falciparum malaria cases in urban Kolkata, India.The present study was a clinic-based study from the Malaria Clinic of the Protozoology Unit of Calcutta School of Tropical Medicine located in the central part of Kolkata. Symptomatic patients from surrounding wards of the Kolkata Municipal Corporation attend this clinic for malaria diagnosis and treatment.This study retrospectively analyzed the data maintained in the Malaria Clinic of the host Institute. The period from 2001-2009 was considered our baseline, and the period from 2010-2013 was considered the post intervention period because ACT was introduced in 2010. The majority of patients were from a nearby locality belonging to a lower socio-economic status. Most of the patients were originally residents of Jharkhand, Bihar, and were mainly migratory workers to Kolkata with frequent visits to their domicile states.Consent was not obtained for each case detection and treatment administered for malaria as these are routine health system activities for clinical care and conducted according to NVBDCP guidelines.All individuals who attended our clinic were exa...

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Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Impact of Artemisinin-Based Combination Therapy on Falciparum Malaria in Urban Kolkata: A Clinic-Based Report

et al. 2015

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“…The changing epidemiology of malaria 1,13,14,27,28 could result in changes in acquisition of clinical immunity. 29,30 Possible consequences of reduced immunity could be shifts in age groups in which severe disease occurs, more severe disease in the population, and disease caused by relatively low parasite densities.…”

Section: Accurate Malaria Diagnosis In Changing Malaria Epidemiology mentioning

confidence: 99%

“…5,6 A consequence of the prolonged neglect of laboratories in malaria case management is that, even when quality laboratory services are available, clinicians too frequently ignore negative results. [7][8][9][10][11][12] The reduction in clinical malaria in several countries [13][14][15][16] and the use of expensive artemisinin-based combination therapeutic (ACT) antimalarial drugs call for case management practices that emphasize parasitologic confirmation, because continued use of ACTs in non-malaria cases represents a waste of resources and eventually, is unsustainable. Indiscriminate use of ACTs could create sufficient drug pressure that hastens development of resistant parasites, a situation that has begun to develop in Southeast Asia.…”

Section: Introductionmentioning

confidence: 99%

Factoring Quality Laboratory Diagnosis into the Malaria Control Agenda for Sub-Saharan Africa

Aidoo

2013

The American Journal of Tropical Medicine and Hygiene

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Abstract. Recent progress in malaria control in sub-Saharan Africa has been achieved primarily through provision of insecticide-treated nets, indoor residual spraying, and antimalarial drugs. Although these interventions are important, proper case identification and accurate measurement of their impact depend on quality diagnostic testing. Current availability of diagnostic testing for malaria in sub-Saharan Africa is inadequate to support disease management, prevention programs, and surveillance needs. Challenges faced include a dearth of skilled workforce, inadequate health systems infrastructure, and lack of political will. A coordinated approach to providing pre-service clinical and laboratory training together with systems that support a scale-up of laboratory services could provide means not only for effective malaria case management but also, management of non-malaria febrile illnesses, disease surveillance, and accurate control program evaluation. A synthesis of the challenges faced in ensuring quality malaria testing and how to include this information in the malaria control and elimination agenda are presented.

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“…The intensification of malaria control interventions, including long-lasting insecticidal nets (LLINs), indoor residual spraying (IRS) of insecticides, and prompt treatment with artemisininbased combination therapies (ACTs) has been accompanied by marked reductions in transmission intensity, parasite prevalence, malaria incidence, malaria-associated hospitalizations, and malaria-associated deaths in some settings, [1][2][3][4][5][6] but not others. 7,8 To date, substantial successes in malaria control in sub-Saharan Africa have been mostly limited to relatively low-transmission settings.…”

Section: Introductionmentioning

confidence: 99%

Malaria Transmission, Infection, and Disease at Three Sites with Varied Transmission Intensity in Uganda: Implications for Malaria Control

Kamya¹,

Arinaitwe²,

Wanzira³

et al. 2015

The American Journal of Tropical Medicine and Hygiene

175

272

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Abstract. The intensification of control interventions has led to marked reductions in malaria burden in some settings, but not others. To provide a comprehensive description of malaria epidemiology in Uganda, we conducted surveillance studies over 24 months in 100 houses randomly selected from each of three subcounties: Walukuba (peri-urban), Kihihi (rural), and Nagongera (rural). Annual entomological inoculation rate (aEIR) was estimated from monthly Centers for Disease Control and Prevention (CDC) light trap mosquito collections. Children aged 0.5-10 years were provided longlasting insecticidal nets (LLINs) and followed for measures of parasite prevalence, anemia and malaria incidence. Estimates of aEIR were 2.8, 32.0, and 310 infectious bites per year, and estimates of parasite prevalence 7.4%, 9.3%, and 28.7% for Walukuba, Kihihi, and Nagongera, respectively. Over the 2-year study, malaria incidence per person-years decreased in Walukuba (0.51 versus 0.31, P = 0.001) and increased in Kihihi (0.97 versus 1.93, P 0.001) and Nagongera (2.33 versus 3.30, P 0.001). Of 2,582 episodes of malaria, only 8 (0.3%) met criteria for severe disease. The prevalence of anemia was low and not associated with transmission intensity. In our cohorts, where LLINs and prompt effective treatment were provided, the risk of complicated malaria and anemia was extremely low. However, malaria incidence was high and increased over time at the two rural sites, suggesting improved community-wide coverage of LLIN and additional malaria control interventions are needed in Uganda.

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Initial evidence of reduction of malaria cases and deaths in Rwanda and Ethiopia due to rapid scale-up of malaria prevention and treatment

Cited by 197 publications

References 6 publications

Impact of Artemisinin-Based Combination Therapy on Falciparum Malaria in Urban Kolkata: A Clinic-Based Report

Impact of Artemisinin-Based Combination Therapy on Falciparum Malaria in Urban Kolkata: A Clinic-Based Report

Factoring Quality Laboratory Diagnosis into the Malaria Control Agenda for Sub-Saharan Africa

Malaria Transmission, Infection, and Disease at Three Sites with Varied Transmission Intensity in Uganda: Implications for Malaria Control

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