Trends in reported malaria cases and the effects of malaria control in the Democratic Republic of the Congo

Abstract

Background Considerable upscaling of malaria control efforts have taken place over the last 15 years in the Democratic Republic of Congo, the country with the second highest malaria case load after Nigeria. Malaria control interventions have been strengthened in line with the Millenium Development Goals. We analysed the effects of these interventions on malaria cases at health facility level, using a retrospective trend analysis of malaria cases between 2005 and 2014. Data were collected from outpatient and laboratory registers based on a sample of 175 health facilities that represents all eco-epidemiological malaria settings across the country. Methods We applied a time series analysis to assess trends of suspected and confirmed malaria cases, by health province and for different age groups. A linear panel regression model controlled for non-malaria outpatient cases, rain fall, nightlight intensity, health province and time fixed effects, was used to examine the relationship between the interventions and malaria case occurrences, as well as test positivity rates. Results Overall, recorded suspected and confirmed malaria cases in the DRC have increased. The sharp increase in confirmed cases from 2010 coincides with the introduction of the new treatment policy and the resulting scale-up of diagnostic testing. Controlling for confounding factors, the introduction of rapid diagnostic tests (RDTs) was significantly associated with the number of tested and confirmed cases. The test positivity rate fluctuated around 40% without showing any trend. Conclusion The sharp increase in confirmed malaria cases from 2010 is unlikely to be due to a resurgence of malaria, but is clearly associated with improved diagnostic availability, mainly the introduction of RDTs. Before that, a great part of malaria cases were treated based on clinical suspicion. This finding points to a better detection of cases that potentially contributed to improved case management. Furthermore, the expansion of diagnostic testing along with the increase in confirmed cases implies that before 2010, cases were underreported, and that the accuracy of routine data to describe malaria incidence has improved.

Effect of Free Healthcare Policy for Children under Five Years Old on the Incidence of Reported Malaria Cases in Burkina Faso by Bayesian Modelling: “Not only the Ears but also the Head of the Hippopotamus”

“…The latter intervention improved the availability of RDTs at the community level [8,9]. The effect of the introduction of malaria RDT on the number of tested and confirmed cases is in line with the result of a study carried out in the Democratic Republic of the Congo in 2017 [15].…”

“…In this study, we used routinely collected data to explore, firstly, the spatio-temporal pattern of malaria (suspected, tested, and confirmed) between 2013 and 2018, and secondly, to assess the effect of the free-of-charge health care policy on malaria reported cases incidence in Burkina Faso. Most studies in this field focused on the effects of interventions, such as ITNs, malaria diagnosis, and treatment, and our study is the first to provide evidence on the associations between the free-of-charge health care policy for children under five and malaria morbidity [15,38,[43][44][45].…”

“…Our findings show that the increase in the number of confirmed malaria cases is most likely the result of the strengthening of specific components of the health system in recent years, particularly the free-of-charge health care that led to an increase in the number of visits among children. This increase in the number of confirmed malaria cases could be also explained by the strengthening of diagnostic and case management capacities, combined with improved registration and reporting practices [15]. Indeed, the number of consultations (health facility attendance) as well as that of the tested and confirmed cases increased considerably after 2016 [7].…”

“…These include the systematic use of rapid diagnostic test (RDT) in malaria diagnostic (in 2013), integration of malaria data into the Health Information System 2 (DHIS2), results-based financing (in 2014), seasonal chemoprevention campaigns (in 2014), decentralization of health care through the 130 Communes project (in 2015), use of community-based health workers (in 2016), and free-of-charge health care for children younger than 5 years (in 2016). These measures should enable health facilities to diagnose all true cases of malaria (see the hippopotamus almost entirely) in a comprehensive way [15] and treat them effectively (decrease the progression of cases to adverse outcomes, i.e., death). This is achieved by significantly improving the population's access to health care, as well as the availability of diagnostic methods and the promptness and completeness of data reporting (improvement of the routine surveillance system).…”

Relationships between test positivity rate, total laboratory confirmed cases of malaria, and malaria incidence in high burden settings of Uganda: An ecological analysis

“…However, TCM is directly dependent on access to care and diagnositc testing and therefore highly susceptible to bias by these factors. For example, in a study from the Democratic Republic of the Congo evaluating trends in reported malaria cases between 2005 and 2014, a sharp increase in con rmed cases after 2010 was presumed to be due to the introduction and scale up in RDTs rather than a true increase in the incidence of malaria [25]. The study presented in this report bene ted from an enhanced surveillance system where almost all patients with suspected malaria underwent diagnostic testing using an RDT.…”