Abstract
BackgroundDespite the well-documented clinical efficacy of artemisinin-based combination therapy (ACT) against malaria, the population-level effects of ACT have not been studied thoroughly until recently. An ideal case study for these population-level effects can be found in Vietnam’s gradual adoption of artemisinin in the 1990s.Methods and resultsAnalysis of Vietnam’s national annual malaria reports (1991–2014) revealed that a 10% increase in artemisinin procurement corresponded to a 32.8% (95% CI 27.7–37.5%) decline in estimated malaria cases. There was no consistent national or regional effect of vector control on malaria. The association between urbanization and malaria was generally negative and sometimes statistically significant.ConclusionsThe decline of malaria in Vietnam can largely be attributed to the adoption of artemisinin-based case management. Recent analyses from Africa showed that insecticide-treated nets had the greatest effect on lowering malaria prevalence, suggesting that the success of interventions is region-specific. Continuing malaria elimination efforts should focus on both vector control and increased access to ACT.
Highlights
Despite the well-documented clinical efficacy of artemisinin-based combination therapy (ACT) against malaria, the population-level effects of ACT have not been studied thoroughly until recently
The decline of malaria in Vietnam can largely be attributed to the adoption of artemisinin-based case management
Continuing malaria elimination efforts should focus on both vector control and increased access to ACT
Summary
Despite the well-documented clinical efficacy of artemisinin-based combination therapy (ACT) against malaria, the population-level effects of ACT have not been studied thoroughly until recently. Over the past 15 years, scale-up in key tools to prevent and treat malaria has contributed to a dramatic reduction in transmission worldwide [1] Principal among these tools have been insecticide-treated nets, indoor residual insecticide spraying, and artemisinin-based combination therapy (ACT)—the most effective anti-malarial therapy currently available for treatment of uncomplicated Plasmodium falciparum. Beyond its well-established clinical efficacy, artemisinin may have population-level benefits in malaria control due to its moderate effect of reducing post-treatment carriage of gametocytes [14,15,16,17]—the sexual stage of malaria transmitted from human peripheral blood to Anopheles mosquitoes. The long-term population-level effects of ACT case management on parasite transmission are only beginning to be documented through retrospective analyses [1, 23, 24], prospective
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