Retrospective data analyses of social and environmental determinants of malaria control for elimination prospects in Eritrea

Selam Mihreteab,Aman Goitom,Muhammad Yousaf Shad,Ubydul Haque,Bingxin Zhao,Ajlina Karamehic-Muratovic,Jailos Lubinda,Alfonso J Rodriguez-Morales

doi:10.1186/s13071-020-3974-x

Abstract

BackgroundThe present study focuses on both long- and short-term malaria transmission in Eritrea and investigates the risk factors. Annual aggregates of information on malaria cases, deaths, diagnostics and control interventions from 2001 to 2008 and monthly reported data from 2009 to 2017 were obtained from the National Malaria Control Programme. We used a generalized linear regression model to examine the associations among total malaria cases, death, insecticide-treated net coverage, indoor residual spraying and climatic parameters.ResultsReduction in malaria mortality is demonstrated by the milestone margins of over 97% by the end of 2017. Malaria incidence likewise declined during the period (from 33 to 5 per 1000 population), representing a reduction of about 86% (R2 = 0.3) slightly less than the decline in mortality. The distribution of insecticide treated nets generally declined between 2001 and 2014 (R2 = 0.16) before increasing from 2015 to 2017, while the number of people protected by indoor residual spraying slightly increased (R2 = 0.27). Higher rainfall was significantly associated with an increased number of malaria cases. The covariates rainfall and temperature are a better pair than IRS and LLIN to predict incidences. On the other hand, IRS and LLIN is a more significant pair to predict mortality cases.ConclusionsWhile Eritrea has made significant progress towards malaria elimination, this progress should be maintained and further improved. Distribution, coverage and utilization of malaria control and elimination tools should be optimized and sustained to safeguard the gains made. Additionally, consistent annual performance evaluation of malaria indicators would ensure a continuous learning process from gains/threats of epidemics and resurgence in regions already earmarked for elimination.

Highlights

The present study focuses on both long- and short-term malaria transmission in Eritrea and investi‐ gates the risk factors
We reviewed the progress made from 2001 to 2017, analyzed risk factors using 2009–2017 monthly reported data, discussed the major strategic efforts and implications of interventions implemented and investigated the role of climatic parameters in the spread of malaria cases in Eritrea
The determinant of the correlation matrix lies between zero and one, and there might be some degree of multicollinearity in the exploratory section of the model

Summary

Introduction

The present study focuses on both long- and short-term malaria transmission in Eritrea and investi‐ gates the risk factors. Following a nationwide malaria epidemic in 1998, Eritrea has made remarkable progress on basic health indices [1], most notably in reducing malaria incidence (80%) and mortality (90%) by 2015 compared with the 1998 baseline [2]. This progress placed Eritrea in the spotlight as one of Africa’s model countries in malaria control. Eritrea’s target for malaria incidence and mortality reduction is 40% and 75% by 2020 and 2025, respectively, with the long-term goal to eliminate and prevent re-establishment of malaria by 2030 [6]

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Results

Discussion

Conclusion