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. 2011 Feb 18:10:46.
doi: 10.1186/1475-2875-10-46.

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

Maru W Aregawi  1 , Abdullah S Ali, Abdul-wahiyd Al-mafazy, Fabrizio Molteni, Samson Katikiti, Marian Warsame, Ritha J A Njau, Ryuichi Komatsu, Eline Korenromp, Mehran Hosseini, Daniel Low-Beer, Anders Bjorkman, Umberto D'Alessandro, Marc Coosemans, Mac Otten
Affiliations

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

Maru W Aregawi et al. Malar J. .

Abstract

Background: In 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.

Methods: Numbers 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.

Results: In 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.

Conclusions: Scaling-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.

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Figures

Figure 1
Figure 1
In-patient cases due to malaria, anaemia and other causes in children under 5 years and >5 years old, 6 hospitals in Zanzibar.
Figure 2
Figure 2
In-patient deaths due to malaria, anaemia and other causes in children under 5 years and >5 years old, 6 hospitals in Zanzibar.
Figure 3
Figure 3
In-patient (a) cases and (b) deaths due to malaria, children under-5 years, in individual hospitals.
Figure 4
Figure 4
Out-patient cases due to malaria, anaemia and other causes, (a) children under-5 and (b) older ages; (c) malaria slide positivity rates and (d) numbers of slides examined for malaria, 6 hospitals in Zanzibar.
Figure 5
Figure 5
Seasonal patterns in malaria and anaemia in-patient cases, children under-5, and monthly rainfall.
See this image and copyright information in PMC

References

    1. Craig MH, Snow RW, Le Sueur D. A climate-based distribution model of malaria transmission in sub-Saharan Africa. Parasitol Today. 1999;15:105–111. doi: 10.1016/S0169-4758(99)01396-4. - DOI - PubMed
    1. Ijumba JN, Mcha JH, Ramsan M, Molteni F, Abdullah A. Vectorial capacity and entomological inoculation rate of malaria vectors in Zanzibar: pre-spraying. University of Dar es Salaam, Department of Zoology & Wildlife Conservation, Zanzibar Malaria Control Programme, and Cooperazione Italiana. 2007.
    1. Lemnge MM, Ali AS, Malecela EK, Sambu E, Abdulla R, Juma ms, Fakih K, Abdulla KH, Njau RJ. Therapeutic efficacy of sulfadoxine-pyrimethamine and amodiaquine among children with uncomplicated Plasmodium falciparum malaria in Zanzibar, Tanzania. Am J Trop Med Hyg. 2005;73:681–685. - PubMed
    1. Zanzibar Revolutionary Government. Rollback malaria indicator survey main report. Ministry of Health and Social Welfare, Zanzibar; 2008.
    1. Korenromp EL, Armstrong-Schellenberg JR, Williams BG, Nahlen BL, Snow RW. Impact of malaria control on childhood anaemia in Africa -- a quantitative review. Trop Med Int Health. 2004;9:1050–1065. doi: 10.1111/j.1365-3156.2004.01317.x. - DOI - PubMed

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