Reductions in malaria and anaemia case and death burden at hospitals following scale-up of malaria control in Zanzibar, 1999-2008

Abstract

BackgroundIn Zanzibar, the Ministry of Health and partners accelerated malaria control from September 2003 onwards. The impact of the scale-up of insecticide-treated nets (ITN), indoor-residual spraying (IRS) and artemisinin-combination therapy (ACT) combined on malaria burden was assessed at six out of seven in-patient health facilities.MethodsNumbers of outpatient and inpatient cases and deaths were compared between 2008 and the pre-intervention period 1999-2003. Reductions were estimated by segmented log-linear regression, adjusting the effect size for time trends during the pre-intervention period.ResultsIn 2008, for all age groups combined, malaria deaths had fallen by an estimated 90% (95% confidence interval 55-98%)(p < 0.025), malaria in-patient cases by 78% (48-90%), and parasitologically-confirmed malaria out-patient cases by 99.5% (92-99.9%). Anaemia in-patient cases decreased by 87% (57-96%); anaemia deaths and out-patient cases declined without reaching statistical significance due to small numbers. Reductions were similar for children under-five and older ages. Among under-fives, the proportion of all-cause deaths due to malaria fell from 46% in 1999-2003 to 12% in 2008 (p < 0.01) and that for anaemia from 26% to 4% (p < 0.01). Cases and deaths due to other causes fluctuated or increased over 1999-2008, without consistent difference in the trend before and after 2003.ConclusionsScaling-up effective malaria interventions reduced malaria-related burden at health facilities by over 75% within 5 years. In high-malaria settings, intensified malaria control can substantially contribute to reaching the Millennium Development Goal 4 target of reducing under-five mortality by two-thirds between 1990 and 2015.

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

“…30 Many reports from Africa have demonstrated significant declines in malaria morbidity and mortality following the scale-up of available malaria control interventions such as LLINs and ACTs, although most of these reports come from areas with low to moderate baseline levels of transmission intensity. 1,2,[4][5][6]31,32 In contrast, recent reports from sites in Malawi with intermediate to high transmission intensity have documented no change or increased malaria burden, despite a modest scale-up of control interventions. 7,33 In a high transmission site from Senegal, scale-up of LLINs was initially associated with a decline in malaria incidence but subsequently malaria incidence rose to almost pre-intervention levels, corresponding with increasing pyrethroid resistance of mosquito vectors.…”

“…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.…”

RTS,S malaria vaccine development: progress and considerations for postapproval introduction

“…[2][3][4] In spite of significant achievements, some countries in Africa still show stable (moderate-to-high) malaria transmission and are without any substantial reduction in malaria disease. 1 The mutating nature of the Plasmodium species makes it necessary to control malaria with all effective methods simultaneously.…”

Untitled

“…Tanzania, the same number of other African nations, is encountering a move in illness transmission designs with respect to febrile irresistible maladies. While the quantity of instances of intestinal sickness are diminishing in a few nations of subSaharan Africa [12][13][14][15], the quantity of febrile cases because of different causes than jungle fever are still high [16].…”