Impact of Artemisinin-Based Combination Therapy and Insecticide-Treated Nets on Malaria Burden in Zanzibar

By Achuyt Bhattarai, A. Ali, S. Kachur, A. Mårtensson, A. Abbas, Rashid A. Khatib, Abdul-wahiyd H Al-mafazy, M. Ramsan, Guida Rotllant, J. Gerstenmaier and 5 more. PLoS Medicine, 2007

659 citations recorded by the source corpus.

Background The Roll Back Malaria strategy recommends a combination of interventions for malaria control. Zanzibar implemented artemisinin-based combination therapy (ACT) for uncomplicated malaria in late 2003 and long-lasting insecticidal nets (LLINs) from early 2006. ACT is provided free of charge to all malaria patients, while LLINs are distributed free to children under age 5 y (“under five”) and pregnant women. We investigated temporal trends in Plasmodium falciparum prevalence and malaria-related health parameters following the implementation of these two malaria control interventions in Zanzibar. Methods and Findings Cross-sectional clinical and parasitological surveys in children under the age of 14 y were conducted in North A District in May 2003, 2005, and 2006. Survey data were analyzed in a logistic regression model and adjusted for complex sampling design and potential confounders. Records from all 13 public health facilities in North A District were analyzed for malaria-related outpatient visits and admissions. Mortality and demographic data were obtained from District Commissioner's Office. P. falciparum prevalence decreased in children under five between 2003 and 2006; using 2003 as the reference year, odds ratios (ORs) and 95% confidence intervals (CIs) were, for 2005, 0.55 (0.28–1.08), and for 2006, 0.03 (0.00–0.27); p for trend < 0.001. Between 2002 and 2005 crude under-five, infant (under age 1 y), and child (aged 1–4 y) mortality decreased by 52%, 33%, and 71%, respectively. Similarly, malaria-related admissions, blood transfusions, and malaria-attributed mortality decreased significantly by 77%, 67% and 75%, respectively, between 2002 and 2005 in children under five. Climatic conditions favorable for malaria transmission persisted throughout the observational period. Conclusions Following deployment of ACT in Zanzibar 2003, malaria-associated morbidity and mortality decreased dramatically within two years. Additional distribution of LLINs in early 2006 resulted in a 10-fold reduction of malaria parasite prevalence. The results indicate that the Millennium Development Goals of reducing mortality in children under five and alleviating the burden of malaria are achievable in tropical Africa with high coverage of combined malaria control interventions.

Subfields: Infectious Diseases, Public Health, Environmental and Occupational Health

View Paper: https://www.semanticscholar.org/paper/d068a34cb909dadf5d89f7f2788438576705dd9e

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Citations in the corpus

A World Malaria Map: Plasmodium falciparum Endemicity in 2007 (2009, background): “An increasing body of evidence points to these intervention effects being substantial, to have accelerated in the post 2000 period, and to represent a spatial mosaic of influence that would act to confound substantially any modelled relationships [82–90].”
Reducing Plasmodium falciparum Malaria Transmission in Africa: A Model-Based Evaluation of Intervention Strategies (2010, background): “Previously, many countries had already intensified their own malaria control programs with much success in reducing both the burden of disease and ongoing transmission [1–4,13,14].”
Malaria: progress, perils, and prospects for eradication. (2008, positive): “Recent evidence that a similar impact can be achieved comes from a study in Zanzibar (8), which”
Epidemiology and Infectivity of Plasmodium falciparum and Plasmodium vivax Gametocytes in Relation to Malaria Control and Elimination (2011, background): “These broad-scale estimates from countries where malaria is endemic (178), together with specific country examples (23, 24, 35, 87, 174, 227, 328, 329), have highlighted the recent trend of decreasing malaria transmission intensity in many areas of endemicity, and these observations, at least in par”