Review of the malaria epidemiology and trends in Zambia

Masaninga, Freddie; Chanda, Emmanuel; Chanda‐Kapata, Pascalina; Hamainza, Busiku; Masendu, Hieronymo Takudzwa; Kamuliwo, Mulakwa; Kapelwa, Wambinji; Chimumbwa, John; Govere, J.; Otten, Mac W.; Fall, Ibrahima Socé; Babaniyi, Olusegun

doi:10.1016/s2221-1691(13)60030-1

Cited by 70 publications

(75 citation statements)

References 8 publications

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“…2,3 HIVinfected pregnant women have reduced antimalarial immunity 4 and, when infected, higher burdens of the malaria parasite. [5][6][7][8][9] Malaria-infected pregnant women have increased CD4+ cell activation, upregulation of proinflammatory cytokines, and increased HIV RNA viral loads.…”

Section: Introductionmentioning

confidence: 99%

“…5,10 Considerable efforts have been made to combat malaria burden in Zambia, and while there has been a resurgence of malaria in the country, in Lusaka Province, malaria transmission is very low with < 1% parasite prevalence. 2 Distinct guidelines for the treatment and prophylaxis of HIV and malaria infection, particularly for pregnant women, may not be appropriate for the overlap in these epidemics. For example, Zambian guidelines recommend malaria prophylaxis with sulfadoxine-pyrimethamine (SP) for all pregnant women during the course of pregnancy given monthly at each scheduled antenatal care (ANC) visit starting at 16 weeks of gestation to achieve a total of three of more doses.…”

Section: Introductionmentioning

confidence: 99%

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Dosage of Sulfadoxine–Pyrimethamine and Risk of Low Birth Weight in a Cohort of Zambian Pregnant Women in a Low Malaria Prevalence Region

Stoner

Vwalika

Smid

et al. 2017

The American Society of Tropical Medicine and Hygiene

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Abstract. In Lusaka, Zambia, where malaria prevalence is low, national guidelines continue to recommend that all pregnant women receive sulfadoxine-pyrimethamine (SP) for malaria prophylaxis monthly at every scheduled antenatal care visit after 16 weeks of gestation. Human immunodeficiency virus (HIV)-positive women should receive co-trimoxazole prophylaxis for HIV and not SP, but many still receive SP. We sought to determine whether increased dosage of SP is still associated with a reduced risk of low birth weight (LBW) in an area where malaria transmission is low. Our secondary objective was to determine whether any association between SP and LBW is modified by receipt of antiretroviral therapy (ART). We analyzed data routinely collected from a cohort of HIV-positive pregnant women with singleton births in Lusaka, Zambia, between February 2006 and December 2012. We used a logPoisson model to estimate the risk of LBW by dosage of SP and to determine whether the association between SP and LBW varied by receipt of ART. Risk of LBW declined as the number of doses increased and appeared lowest among women who received three doses (adjusted risk ratio [ARR] = 0.78; 95% confidence interval [CI] = 0.64-0.95). In addition, women receiving combination ART had a higher risk of delivering an LBW infant compared with women receiving no treatment or prophylaxis (ARR = 1.18; 95% CI = 1.09-1.28), but this risk was attenuated among women who were receiving SP (risk ratio = 1.09; 95% CI = 0.99-1.21). SP was associated with a reduced risk of LBW in HIVpositive women, including those receiving ART, in a low malaria prevalence region.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Dosage of Sulfadoxine–Pyrimethamine and Risk of Low Birth Weight in a Cohort of Zambian Pregnant Women in a Low Malaria Prevalence Region

Stoner

Vwalika

Smid

et al. 2017

The American Society of Tropical Medicine and Hygiene

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“…In 2010, malaria incidence was 330 per 1000 people per year for all ages and 897 for children under the age of five, while fatality rates reached 34 per 1000 hospital admissions per year [21]. Also, while transmission rates in some districts (e.g., those in Lusaka) reached very low levels by 2010, in others they remained low or moderate (e.g., those in Central, Western, and Southern Provinces), or even moderate to high (e.g., those in Eastern, Northern, Muchinga, and Luapula Provinces) [22]. The authors attempted to exploit this variation in malaria incidence and malaria control coverage by district to identify the relationship between malaria control scale-up and micro-economic outcomes.…”

Section: Methodsmentioning

confidence: 99%

Exploring the use of routinely-available, retrospective data to study the association between malaria control scale-up and micro-economic outcomes in Zambia

Comfort

Leegwater

Nakhimovsky

et al. 2017

Malar J

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BackgroundCountry-level evidence on the impact of malaria control on micro-economic outcomes is vital for mobilizing domestic and donor resources for malaria control. Using routinely available survey data could facilitate this investigation in a cost-efficient way.MethodsThe authors used Malaria Indicator Surveys (MIS) and Living Conditions Monitoring Survey (LCMS) data from 2006 to 2010 for all 72 districts in Zambia to relate malaria control scale-up with household food spending (proxy for household well-being), educational attainment and agricultural production. The authors used two quasi-experimental designs: (1) a generalized propensity score for a continuous treatment variable (defined as coverage from owning insecticide-treated bed nets and/or receipt of indoor residual spraying); and, (2) a district fixed effects model to assess changes in the outcome relative to changes in treatment pre-post scale-up. The unit of analysis was at district level. The authors also conducted simulations post-analysis to assess statistical power.ResultsMicro-economic outcomes increased (33% increase in food spending) concurrently with malaria control coverage (62% increase) from 2006 to 2010. Despite using data from all 72 districts, both analytic methods yielded wide confidence intervals that do not conclusively link outcomes and malaria control coverage increases. The authors cannot rule out positive, null or negative effects. The upper bound estimates of the results show that if malaria control coverage increases from 60 to 70%, food spending could increase up to 14%, maize production could increase up to 57%, and years of schooling could increase up to 0.5 years. Simulations indicated that the generalized propensity score model did not have good statistical power.ConclusionWhile it is technically possible to use routinely available survey data to relate malaria control scale-up and micro-economic outcomes, it is not clear from this analysis that meaningful results can be obtained when survey data are highly aggregated. Researchers in similar settings should assess the feasibility of disaggregating existing survey data. Additionally, large surveys, such as LCMS and MIS, could incorporate data on both malaria coverage and household expenditures, respectively.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-016-1665-z) contains supplementary material, which is available to authorized users.

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“…Scaled-up standard containment activities have helped to control malaria in a range of regions and may have contributed to the global decline of malaria prevalence over the last 10 years [130][131][132][133]. This slow strangulation of parasite populations results in the selection of the most resistant parasite strains, which manage to survive despite control efforts [134].…”

Section: Back-burn: Targeted Malaria Eliminationmentioning

confidence: 99%

Fighting fire with fire: mass antimalarial drug administrations in an era of antimalarial resistance

Seidlein

Dondorp

2015

Expert Review of Anti-infective Therapy

102

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The emergence and spread of antimalarial resistance has been a major liability for malaria control. The spread of chloroquine-resistant Plasmodium falciparum strains had catastrophic consequences for people in malaria-endemic regions, particularly in sub-Saharan Africa. The recent emergence of artemisinin-resistant P. falciparum strains is of highest concern. Current efforts to contain artemisinin resistance have yet to show success. In the absence of more promising plans, it has been suggested to eliminate falciparum malaria from foci of artemisinin resistance using a multipronged approach, including mass drug administrations. The use of mass drug administrations is controversial as it increases drug pressure. Based on current knowledge it is difficult to conceptualize how targeted malaria elimination could contribute to artemisinin resistance, provided a full treatment course is ensured.

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Review of the malaria epidemiology and trends in Zambia

Cited by 70 publications

References 8 publications

Dosage of Sulfadoxine–Pyrimethamine and Risk of Low Birth Weight in a Cohort of Zambian Pregnant Women in a Low Malaria Prevalence Region

Dosage of Sulfadoxine–Pyrimethamine and Risk of Low Birth Weight in a Cohort of Zambian Pregnant Women in a Low Malaria Prevalence Region

Exploring the use of routinely-available, retrospective data to study the association between malaria control scale-up and micro-economic outcomes in Zambia

Fighting fire with fire: mass antimalarial drug administrations in an era of antimalarial resistance

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