Abstract
BackgroundWhile the overall burden of malaria is still high, the global technical strategy for malaria advocates for two sets of interventions: vector control-based prevention and diagnosis and prompt effective treatment of malaria cases. This study aimed to assess the performance of malaria interventions on malaria infection and anaemia in irrigated areas in Sudan.MethodsBased on the Sudan 2016 national malaria indicator survey, data for two states (Gezira and Sennar), characterized by large-irrigated schemes, were analysed. Four community-level malaria interventions were used as contextual variables: utilization of malaria diagnosis, utilization of Artemisinin-based combination therapy (ACT), utilization of long-lasting insecticidal nets (LLINs) and coverage with indoor residual spraying (IRS). Association between these interventions and two outcomes: malaria infection and anaemia, was assessed separately. Malaria infection was assessed in all age groups while anaemia was assessed in children under 5 years. Multilevel multiple logistic regression analysis were conducted.ResultsAmong 4478 individuals involved in this study distributed over 47 clusters, the overall malaria infection rate was 3.0% and 56.5% of the children under 5 years (total = 322) were anaemic. Except for IRS coverage (69.6%), the average utilization of interventions was relatively low: 52.3% for utilization of diagnosis, 33.0% for utilization of ACTs and 18.6% for LLINs utilization. The multi-level multiple logistic regression model showed that only IRS coverage was associated with malaria infection (Odds ratio 0.83 per 10% coverage, 95%Confidence Interval (95%CI) 0.74–0.94, p = 0.003) indicating that a higher level of IRS coverage was associated with less malaria infection. Anaemia was not associated with any intervention (all p values larger than 0.1).ConclusionsMalaria transmission in Gezira and Sennar areas is low. IRS, with insecticide to which vectors are susceptible, is an effective malaria control intervention in irrigated schemes. Community utilization of other interventions was not associated with malaria infection in this study. This may be due to the low utilization of these interventions. However, individual use of LLINs provide personal protection. This study failed to establish an association between anaemia and malaria control interventions in low transmission areas. The higher level of malaria infection in urban areas is a cause for concern.
Highlights
While the overall burden of malaria is still high, the global technical strategy for malaria advocates for two sets of interventions: vector control-based prevention and diagnosis and prompt effective treatment of malaria cases
To assess if adding these variables could improve the model fit Malaria infection A total of 4478 surveyed individuals (15.6% of them were under 5 years old) from two irrigated areas in Sudan, distributed over 47 clusters, were included in the analysis of this study
Malaria infection was relatively high among males (3.7%, 95% Confidence interval (95%CI) 1.8–7.3) compared to females (2.6%, 95%CI 1.5–4.4) (p = 0.035) while it was relatively low in rural areas (1.8%, 95%CI 1.2–2.8) compared to urban areas (8.1%, 95%CI 3.0–20.2) (p = 0.003) (Table 1)
Summary
While the overall burden of malaria is still high, the global technical strategy for malaria advocates for two sets of interventions: vector control-based prevention and diagnosis and prompt effective treatment of malaria cases. The risk of malaria endemicity is determined by many factors including the area of residence (urban or rural) and the level of interventions coverage [7]. The World Health Organization’s (WHO) updated global technical strategy for malaria calls for universal access to malaria prevention, diagnosis and treatment, recommending two complementarity sets of interventions of (1) vector control-based prevention and (2) timely diagnosis and prompt effective treatment [8]. The WHO recommends the use of artemisinin-based combination therapy (ACT) for the treatment of malaria cases [9]. For the rational use of the ACTs, all suspected malaria cases should have undergone a parasitological confirmatory diagnostic test [10, 11]
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