Abstract
BackgroundIntensive malaria control may have additional benefits beyond reducing the incidence of symptomatic malaria. We compared antibiotic treatment of children before and after the implementation of highly effective malaria control interventions in Tororo, a historically high transmission area of Uganda.MethodsTwo successive cohorts of children, aged 0.5 to 10 years, were followed from September 2011 to October 2019 in a dedicated study clinic. Universal distribution of long-lasting insecticidal nets was conducted in 2013 and 2017. Sustained indoor residual spraying of insecticide (IRS) was initiated in December 2014. Generalized linear mixed-effects models were used to compare the incidence of antimalarial and antibiotic treatments before and after vector control measures were implemented.ResultsComparing the period prior to the implementation of IRS to the period after IRS had been sustained for 4–5 years, the adjusted incidence of malaria treatments decreased from 2.68 to 0.05 per person-year (incidence rate ratio [IRR] = 0.02, 95% CI 0.01–0.03, p < 0.001), and the adjusted incidence of antibiotic treatments decreased from 4.14 to 1.26 per person-year (IRR = 0.30, 95% CI 0.27–0.34, p < 0.001). The reduction in antibiotic usage was primarily associated with fewer episodes of symptomatic malaria and fewer episodes of fever with sub-microscopic parasitemia, both of which were frequently treated with antibiotics.ConclusionsIn a historically high transmission setting, the implementation of highly effective vector control interventions was followed by a marked reduction in antibiotic treatment of children. This added benefit of malaria control could have important implications for antibiotic prescribing practices, efforts to curtail antimicrobial resistance, and health system costs.
Highlights
Intensive malaria control may have additional benefits beyond reducing the incidence of symptomatic malaria
Changes in the incidence of malaria treatments following implementation of indoor residual spraying (IRS) Prior to the implementation of IRS, malaria treatments followed a seasonal pattern with two annual peaks and an adjusted average of 2.68 treatments per person-year (Fig. 2 and Table 1)
In the first 3 years following the implementation of IRS, there was a 53% reduction in the incidence of antibiotic treatments (IRR = 0.47, 95% Confidence interval (CI) 0.43 to 0.52; p < 0.001)
Summary
Intensive malaria control may have additional benefits beyond reducing the incidence of symptomatic malaria. Vector control interventions aimed at reducing transmission intensity can reduce malaria burden, but reducing malaria may have additional health benefits beyond those attributable to malaria alone [2, 3]. We hypothesized that intensive vector control in a previously hightransmission setting, resulting in the near elimination of malaria, would be associated with reduced antibiotic use among children. Decisions about the use of antibiotics during clinical encounters are inextricably entwined with the burden of malaria in a community [6] This interrelationship is most apparent during febrile clinical encounters, but even infection with malaria parasites in the absence of fever (i.e., asymptomatic parasitemia) may have an effect on the likelihood of clinical presentation resulting in the use of antibiotics. The effect of malaria control on malaria-specific outcomes and the interaction between malaria diagnoses and antibiotic use have been well-researched, but evidence on the use of antibiotics in the context of successful population-level malaria control is limited
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
