Confirmed Malaria Cases Research Articles

No evidence of decline in malaria burden from 2006 to 2013 in a rural Province of Gabon: implications for public health policy.

BackgroundThe morbidity of malaria has steady declined in the urban regions of Gabon between 2000 and 2008, but caution should be exercised before generalizing this trend to the whole country because this finding has not been systematically confirmed in remote rural provinces.MethodsWe conducted a retrospective survey using data on malaria cases recorded in North Eastern Gabon between 2006 and 2013 at health facilities in Makokou. Malaria data were analyzed, and associations with annual variations and patient age were assessed.ResultsA global increase in clinical and confirmed malaria cases was observed over the study period. The rate of infection was significantly higher in children aged between 0 to 4 years than in children of 5 years and above, and in adults. Contrary to prior observations in urban and semi-urban areas of Gabon, malaria burden remained mostly unchanged or even increased in Makokou in the Ogooué-Ivindo province during these last 8 years.ConclusionsThe persistence of Plasmodium falciparum pockets of sustained malaria transmission in rural Gabon may be related to an inadequate coverage of key interventions, to poor treatment seeking behavior and/or to a decline efficacy of treatments. Our results highlight the need to better adapt malaria control strategies to local epidemiological contexts and to environmental constraints. Equitable delivery of health service to hard-to-reach populations constitutes a challenging issue for the health authorities of Gabon.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1456-4) contains supplementary material, which is available to authorized users.

Treatment of Febrile illness with artemisinin combination therapy: prevalence and predictors in five African household surveys.

ObjectivesTo evaluate the determinants of compliance with national policies recommending Artemisinin Combination Therapy (ACT) for the treatment of uncomplicated malaria in the community.MethodsWe used data from Gambia, Ghana, Kenya, Nigeria, and Uganda national household surveys that were conducted with a standardized World Health Organization (WHO) methodology to measure access to and use of medicines. We analyzed all episodes of acute fever reported in the five surveys. We used logistic regression models accounting for the clustered design of the surveys to identify determinants of seeking care in public healthcare facilities, of being treated with antimalarials, and of receiving ACT.ResultsOverall, 92% of individuals with a febrile episode sought care outside the home, 96% received medicines, 67% were treated with antimalarials, and 16% received ACT. The choice of provider was influenced by perceptions about medicines availability and affordability. In addition, seeking care in a public healthcare facility was the single most important predictor of treatment with ACT [odds ratio (OR): 4.64, 95% confidence intervals (CI): 2.98–7.22, P < 0.001]. Children under 5 years old were more likely than adults to be treated with antimalarials [OR: 1.28, CI: 0.91–1.79, not significant (NS)] but less likely to receive ACT (OR: 0.80, CI: 0.57–1.13, NS).ConclusionsOur results confirm the high prevalence of presumptive antimalarial treatment for acute fever, especially in public healthcare facilities where poor people seek care. They show that perceptions about access to medicines shape behaviors by directing patients and caregivers to sources of care where they believe medicines are accessible. The success of national policies recommending ACT for the treatment of uncomplicated malaria depends not only on restricting ACT to confirmed malaria cases, but also on ensuring that ACT is available and affordable for those who need it.

Influence of Wasting and Underweight on Malaria Status among Ethiopian Children Aged 6-59 Months: A Facility Based Case Control Study

Background: Malaria and under-nutrition are among the major causes of childhood mortality in Sub-Saharan Africa including Ethiopia. Although the synergistic relationship of malnutrition and infection are widely documented, the influence of under-nutrition on malaria attack is controversial. This study has addressed the contributory effect of wasting and underweight on malaria status of children. Methodology: An unmatched case control study was employed to assess the influence of wasting and underweight on malaria among children in Ethiopia. A total of 621 sampled children were enrolled and allocated proportionally across the six randomly selected health centers. Children with confirmed malaria were enrolled as cases and for every confirmed malaria case; three controls that visited the facility for fever other than malaria were interviewed based on their order of visiting. Clinical data, anthropometric measurements and blood film was taken by trained personnel. The anthropometric data were converted into nutritional indices using the WHO Anthro software version 3.2.2 and exported to SPSS version 21 for cleaning and further analysis. Result: The overall wasting was significantly associated with confirmed malaria cases. The odds of developing malaria was 2.4 times more among wasted than non-wasted children (AOR=2.440; 95% CI=1.146 to 5.197); and 1.7 times more among underweight children than the referent group (AOR=1.69; 95%CI=1.11 to 2.9). Conclusion: Being wasted and underweight contributed to the magnitude of malaria and affected the health and nutrition related response. Therefore, integration of nutrition surveillance with malaria control program is essential

Identifying malaria hotspots in Keur Soce health and demographic surveillance site in context of low transmission.

BackgroundMalaria is major public health problem in Senegal. In some parts of the country, it occurs almost permanently with a seasonal increase during the rainy season. There is evidence to suggest that the prevalence of malaria in Senegal has decreased considerably during the past few years. Recent data from the Senegalese National Malaria Control Programme (NMCP) indicates that the number of malaria cases decrease from 1,500,000 in 2006 to 174,339 in 2010. With the decline of malaria morbidity in Senegal, the characterization of the new epidemiological profile of this disease is crucial for public health decision makers.MethodsSaTScan™ software using the Kulldorf method of retrospective space-time permutation and the Bernoulli purely spatial model was used to identify malaria clusters using confirmed malaria cases in 74 villages. ArcMAp was used to map malaria hotspots. Logistic regression was used to investigate risk factors for malaria hotspots in Keur Soce health and demographic surveillance site.ResultsA total of 1,614 individuals in 440 randomly selected households were enrolled. The overall malaria prevalence was 12%. The malaria prevalence during the study period varied from less than 2% to more than 25% from one village to another. The results showed also that rooms located between 50 m to 100 m away from livestock holding place [adjusted O.R = 0.7, P = 0.044, 95% C.I (1.02 - 7.42)], bed net use [adjusted O.R = 1.2, P = 0.024, 95% C.I (1.02 –1.48)], are good predictors for malaria hotspots in the Keur Soce health and demographic surveillance site. The socio economic status of the household also predicted on hotspots patterns. The less poor household are 30% less likely to be classified as malaria hotspots area compared to the poorest household [adjusted O.R = 0.7, P = 0.014, 95% C.I (0.47 – 0.91)].ConclusionThe study investigated risk factors for malaria hotspots in small communities in the Keur Soce site. The result showed considerable variation of malaria prevalence between villages which cannot be detected in aggregated data. The data presented in this paper are the first step to understanding malaria in the Keur Soce site from a micro-geographic perspective.

A methodological framework for the improved use of routine health system data to evaluate national malaria control programs: evidence from Zambia.

BackgroundDue to challenges in laboratory confirmation, reporting completeness, timeliness, and health access, routine incidence data from health management information systems (HMIS) have rarely been used for the rigorous evaluation of malaria control program scale-up in Africa.MethodsWe used data from the Zambia HMIS for 2009–2011, a period of rapid diagnostic and reporting scale-up, to evaluate the association between insecticide-treated net (ITN) program intensity and district-level monthly confirmed outpatient malaria incidence using a dose–response national platform approach with district-time units as the unit of analysis. A Bayesian geostatistical model was employed to estimate longitudinal district-level ITN coverage from household survey and programmatic data, and a conditional autoregressive model (CAR) was used to impute missing HMIS data. The association between confirmed malaria case incidence and ITN program intensity was modeled while controlling for known confounding factors, including climate variability, reporting, testing, treatment-seeking, and access to health care, and additionally accounting for spatial and temporal autocorrelation.ResultsAn increase in district level ITN coverage of one ITN per household was associated with an estimated 27% reduction in confirmed case incidence overall (incidence rate ratio (IRR): 0 · 73, 95% Bayesian Credible Interval (BCI): 0 · 65–0 · 81), and a 41% reduction in areas of lower malaria burden.ConclusionsWhen improved through comprehensive parasitologically confirmed case reporting, HMIS data can become a valuable tool for evaluating malaria program scale-up. Using this approach we provide further evidence that increased ITN coverage is associated with decreased malaria morbidity and use of health services for malaria illness in Zambia. These methods and results are broadly relevant for malaria program evaluations currently ongoing in sub-Saharan Africa, especially as routine confirmed case data improve.Electronic supplementary materialThe online version of this article (doi:10.1186/s12963-014-0030-0) contains supplementary material, which is available to authorized users.

Dynamics of Plasmodium falciparium and Plasmodium vivax in a micro-ecological setting, Southwest Ethiopia: effects of altitude and proximity to a dam.

BackgroundRefining the spatial and temporal data on malaria transmissions at a defined ecological setting has practical implications for targeted malaria control and enhancing efficient allocation of resources. Spatial and temporal distribution of P. falciparium and P. vivax were explored around the Gilgel Gibe Hydroelectric Dam (GGHD) in southwest Ethiopia.MethodsA review of confirmed malaria episodes recorded over eight years at primary health services was conducted. Using individual identifiers and village names malaria records were cross-linked to location and individual records of Gilgel Gibe Health and Demographic Surveillance System (HDSS) data, which had already been geo-referenced. The study setting was categorized in to buffer zones with distance interval of one kilometer. Similarly, altitude of the area was categorized considering 100 meters height intervals. Incidence rate ratios were estimated using Poisson model for the buffer zones and for the altitudinal levels by adjusting for the underlying population density as an offset variable. Yearly temporal variations of all confirmed malaria cases were also evaluated based on the Poisson model using STATA statistical software version 12.ResultsA considerable proportion (45.0%) of the P. falciparium episodes were registered within one kilometer radius of the GGHD. P. falciparium showed increment with distance from the GGHD up to five kilometers and with altitude above 1900 meters while P. vivax exhibited the increase with distance but, decrease with the altitude. Both species showed significantly higher infection among males than females (P <0.01). Temporally, malaria episodes manifested significant increments in the years between 2006/7 to 2009/10 while reduction of the malaria episodes was indicated during 2004/5, 2005/6 and 2010/11 compared to 2003/4 (P <0.01). On average, P. vivax was 52% less than P. falciparium over the time period considered. P. vivax was significantly higher in the years 2004/5 to 2007/8 and 2010/11 (P <0.001).ConclusionsSpatial and temporal variations of malaria were observed. The spatial and temporal variations of malaria episodes were also different for the two main malaria species in the area.

Time series analysis of trends in malaria cases and deaths at hospitals and the effect of antimalarial interventions, 2001-2011, Ethiopia.

BackgroundThe Government of Ethiopia and its partners have deployed artemisinin-based combination therapies (ACT) since 2004 and long-lasting insecticidal nets (LLINs) since 2005. Malaria interventions and trends in malaria cases and deaths were assessed at hospitals in malaria transmission areas during 2001–2011.MethodsRegional LLINs distribution records were used to estimate the proportion of the population-at-risk protected by LLINs. Hospital records were reviewed to estimate ACT availability. Time-series analysis was applied to data from 41 hospitals in malaria risk areas to assess trends of malaria cases and deaths during pre-intervention (2001–2005) and post-interventions (2006–2011) periods.FindingsThe proportion of the population-at-risk potentially protected by LLINs increased to 51% in 2011. The proportion of facilities with ACTs in stock exceeded 87% during 2006–2011. Among all ages, confirmed malaria cases in 2011 declined by 66% (95% confidence interval [CI], 44–79%) and SPR by 37% (CI, 20%–51%) compared to the level predicted by pre-intervention trends. In children under 5 years of age, malaria admissions and deaths fell by 81% (CI, 47%–94%) and 73% (CI, 48%–86%) respectively. Optimal breakpoint of the trendlines occurred between January and June 2006, consistent with the timing of malaria interventions. Over the same period, non-malaria cases and deaths either increased or remained unchanged, the number of malaria diagnostic tests performed reflected the decline in malaria cases, and rainfall remained at levels supportive of malaria transmission.ConclusionsMalaria cases and deaths in Ethiopian hospitals decreased substantially during 2006–2011 in conjunction with scale-up of malaria interventions. The decrease could not be accounted for by changes in hospital visits, malaria diagnostic testing or rainfall. However, given the history of variable malaria transmission in Ethiopia, more data would be required to exclude the possibility that the decrease is due to other factors.

Changes in malaria prevalence and management of fevers from 2000 to 2012 in Casamance, Senegal

Before 2006 in Senegal, in the absence of clinical diagnosis, all fever cases were considered as malaria and treated with chloroquine. Between 2004-2006, to face the dramatic increase of Plasmodium falciparum resistance to chloroquine, the combination of amodiaquine plus sulfadoxine-pyriméthamine was recommended for treatment. In 2006, rapid diagnostic tests were introduced and the treatment with a combination of artesunate plus amodiaquine (ASAQ) became the national recommendation for malaria treatment in 2007. This coincided with a decrease of the prevalence of malaria cases and change in fever management. Since 1995 in Mlomp in Casamance, thin and thick blood smear examination has systematically been done in patients with fever and clinical signs of malaria, and treatment with ASAQ given as experimental procedure. Between 2000 and 2012, 70,892 outpatients were attending the health center, and 51.2% of them for fever. Among these fever cases, 72.4% were suspected of malaria and 27.6% were identified as bacterial and viral infections. Confirmed malaria cases decreased dramatically from 1365 in 2000 to 53 in 2012. While comparing the 2 periods 2000-2006 and 2007-2012, the number of fever cases decreased by half, the number of fever identified as non malaria doubled and malaria treatment given decreased by 86%. Improvement of fever management in Mlomp has contributed to a better identification of their cause and to a decrease of inappropriate malaria treatments.

Factors that are associated with the risk of acquiring Plasmodium knowlesi malaria in Sabah, Malaysia: a case-control study protocol

IntroductionPlasmodium knowlesi has long been present in Malaysia, and is now an emerging cause of zoonotic human malaria. Cases have been confirmed throughout South-East Asia where the ranges of its...

A study protocol for a randomised open-label clinical trial of artesunate-mefloquine versus chloroquine in patients with non-severe Plasmodium knowlesi malaria in Sabah, Malaysia (ACT KNOW trial)

IntroductionMalaria due to Plasmodium knowlesi is reported throughout South-East Asia, and is the commonest cause of it in Malaysia. P. knowlesi replicates every 24 h and can cause severe disease...

Where India stands in malaria elimination?

Malaria elimination campaign during the end of the last century relied on insecticides and malaria treatment, but this effort did not succeed in many endemic countries and collapsed after a few decades. India is among the 35 countries, which contribute 96% of total malaria cases and 98% of total malaria deaths in the world (1). Recent studies suggest that the neighboring countries of India are at the edge of eliminating malaria. In Sri lanka, the key component to achieve malaria cases reduction by 99.9% was the ability to be flexible and adapt to changing conditions (2, 3). Mobile malaria clinics were deployed to protect hard-to-reach and displaced population groups. Long-lasting insecticide-treated nets were distributed by engaging non-governmental organizations local to the endemic areas. Bhutan has initiated the use of mobile phones to collect and map information on the location of households, breeding sites, malaria cases, and settlements (4, 5). In India, the malaria control program was initiated in 1953 with an aim of eradication; however, still a number of outbreaks are occurring in different parts of the country. Recent malaria report published by National Vector Borne Diseases Control Program (NVBDCP), Ministry of Health and Family Welfare, and the government of India revealed that there were about 0.88 million confirmed malaria cases and 440 deaths attributed to malaria in 2013 (6). The overall malaria cases and deaths have decreased in recent years in India, but a study funded by NIH, USA and published in Lancet argues that more than 0.2 million Indians die of malaria annually (7). The study further reports that about 90% of malaria related deaths were in rural areas while about 86% took place away from the health centers. A recent study has suggested that there is a certain population in India that does not have access to medical facilities for one or another reason, which further strengthen the claim that many deaths might occur at home without reaching to any reporting facility (8). The actual estimate of malaria mortality in India has been argued in recent years (8, 9). If the data reported in Lancet happen to be true, the substantial underreporting of malaria cases could prove to be a serious disruption of WHO’s anti-malaria effort, which estimated that India is moving toward the “pre-elimination phase” by 2015.

Malaria control in Nepal 1963-2012: challenges on the path towards elimination.

BackgroundMalaria is still a priority public health problem of Nepal where about 84% of the population are at risk. The aim of this paper is to highlight the past and present malaria situation in this country and its challenges for long-term malaria elimination strategies.MethodsMalariometric indicator data of Nepal recorded through routine surveillance of health facilities for the years between 1963 and 2012 were compiled. Trends and differences in malaria indicator data were analysed.ResultsThe trend of confirmed malaria cases in Nepal between 1963 and 2012 shows fluctuation, with a peak in 1985 when the number exceeded 42,321, representing the highest malaria case-load ever recorded in Nepal. This was followed by a steep declining trend of malaria with some major outbreaks. Nepal has made significant progress in controlling malaria transmission over the past decade: total confirmed malaria cases declined by 84% (12,750 in 2002 vs 2,092 in 2012), and there was only one reported death in 2012. Based on the evaluation of the National Malaria Control Programme in 2010, Nepal recently adopted a long-term malaria elimination strategy for the years 2011–2026 with the ambitious vision of a malaria-free Nepal by 2026. However, there has been an increasing trend of Plasmodium falciparum and imported malaria proportions in the last decade. Furthermore, the analysis of malariometric indicators of 31 malaria-risk districts between 2004 and 2012 shows a statistically significant reduction in the incidence of confirmed malaria and of Plasmodium vivax, but not in the incidence of P. falciparum and clinically suspected malaria.ConclusionsBased on the achievements the country has made over the last decade, Nepal is preparing to move towards malaria elimination by 2026. However, considerable challenges lie ahead. These include especially, the need to improve access to diagnostic facilities to confirm clinically suspected cases and their treatment, the development of resistance in parasites and vectors, climate change, and increasing numbers of imported cases from a porous border with India. Therefore, caution is needed before the country embarks towards malaria elimination.

Success or failure of critical steps in community case management of malaria with rapid diagnostic tests: a systematic review.

BackgroundMalaria still causes high morbidity and mortality around the world, mainly in sub-Saharan Africa. Community case management of malaria (CCMm) by community health workers (CHWs) is one of the strategies to combat the disease by increasing access to malaria treatment. Currently, the World Health Organization recommends to treat only confirmed malaria cases, rather than to give presumptive treatment.ObjectivesThis systematic review aims to provide a comprehensive overview of the success or failure of critical steps in CCMm with rapid diagnostic tests (RDTs).MethodsThe databases of Medline, Embase, the Cochrane Library, the library of the ‘Malaria in Pregnancy’ consortium, and Web of Science were used to find studies on CCMm with RDTs in SSA. Studies were selected according to inclusion and exclusion criteria, subsequently risk of bias was assessed and data extracted.Results27 articles were included. CHWs were able to correctly perform RDTs, although specificity levels were variable. CHWs showed high adherence to test results, but in some studies a substantial group of RDT negatives received treatment. High risk of bias was found for morbidity and mortality studies, therefore, effects on morbidity and mortality could not be estimated. Uptake and acceptance by the community was high, however negative-tested patients did not always follow up referral advice. Drug or RDT stock-outs and limited information on CHW motivation are bottlenecks for sustainable implementation. RDT-based CCMm was found to be cost effective for the correct treatment of malaria in areas with low to medium malaria prevalence, but study designs were not optimal.DiscussionTrained CHWs can deliver high quality care for malaria using RDTs. However, lower RDT specificity could lead to missed diagnoses of non-malarial causes of fever. Other threats for CCMm are non-adherence to negative test results and low referral completion. Integrated CCM may solve some of these issues. Unfortunately, morbidity and mortality are not adequately investigated. More information is needed about influencing sociocultural aspects, CHW motivation and stock supply.ConclusionCCMm is generally well executed by CHWs, but there are several barriers for its success. Integrated CCM may overcome some of these barriers.

Imported Malaria in Poland 2003 to 2011: Implications of Different Travel Patterns

The number of imported malaria cases in Poland compared with other European countries remains low. However, in view of the high mortality and the large proportion of severe clinical forms, a better understanding of the problem is required. Data reported to the surveillance system in Poland between 2003 and 2011 were reviewed retrospectively. All cases were laboratory confirmed as outlined by the EU case definition. Statistical analysis was performed using Epi Info 3.5.3 and STATA 10. A total of 189 confirmed malaria cases, including 5 that were fatal, were reported in Poland during the study period. All cases were imported: 72% came from Africa. Among cases with a species-specific diagnosis, 118 (73%) were caused by Plasmodium falciparum. The median age of individuals afflicted was 36 years and 74% were males. Most cases occurred among work-related travelers (40%) or tourists (38%). Individuals born in malaria-endemic countries constituted 12% of all cases. The severe malaria form was identified in 23% of all cases and was more frequent among cases caused by P. falciparum (32%), in people older than 50 years (39%), and in cases when diagnosis was delayed (36%). The severe form occurred only in 9% of cases originating from malaria-endemic countries and there were no fatalities in this group. Fatal outcomes were associated with a delay in diagnosis (fatality = 10.5%) and falciparum malaria (fatality = 4%). Most of the delays resulted from a delay in seeking medical care, and less frequently due to misdiagnosis. Tourists and work-related travelers make up most of the malaria patients in Poland and they are at a greater risk of the severe form of malaria and consequently death, possibly due to the lack of immunity. Delayed diagnosis is associated with mortality, implying low awareness of the threat that malaria poses, both among patients and doctors.

Assessment of complications and outcome in Plasmodium vivax, falciparum and their mixed infections

Background: A paperbased notification system is used for reporting key infectious diseases from primary health care to sub district level. The use of a smart phone for data submission to a central server was piloted in a rural area to improve timeliness. Follow up within 48hours of a malaria diagnosis is required as part of the elimination strategy. Methods & Materials: A designated nurse reported from three clinics in Mpumalanga Province, South Africa from October 2012 to May 2013: weekly data on three infectious disease syndromes; patient-level data on positive malaria cases; and patient-level data for acute febrile illness. The nurse entered data from the paperbased forms to a smart phone and submitted those for further dissemination. A text message was sent to the malaria coordinator for confirmed malaria cases. A qualitative and quantitative evaluation regarding the acceptability, technical feasibility and timeliness of the reporting was performed. Results from themalaria component are reported here. Results: The network connection was sufficient, as the data could be collected offline, stored on the phone and sent by bulk later if connectionwas temporarily unavailable. In total, 23malaria forms were submitted from the three clinics. We compared time from diagnosis to follow up of malaria cases from our clinics with other clinics in the area. The median number of days for follow up was 2 for our clinics. 65% were followed up within 48hours. For 57 other clinics 36%of 236 caseswere followed upwithin 48hours, themedian number of dayswas 4. For the same time period a year earlier (without cell phone reporting) 5% were followed up within 48hours from our clinics (median 13.5 days) compared to 13% and 6 days from the other clinics. Conclusion: The use of cell phone significantly improved the timeliness of data transmission, was acceptable to users and technically feasible in this rural area. For malaria reporting, time to follow up improved compared to other clinics and to the previous year because of the sms alerts. Althoughmalaria case numbers were small, consideration should be given to larger scale usewithin the malaria programme.

Malaria burden and control in Bangladesh and prospects for elimination: an epidemiological and economic assessment.

Malaria is endemic in 13 of 64 districts in Bangladesh. About 14 million people are at risk. Some evidence suggests that the prevalence of malaria in Bangladesh has decreased since the the Global Fund to Fight AIDS, Tuberculosis and Malaria started to support the National Malaria Control Program (NMCP) in 2007. We did an epidemiological and economic assessment of malaria control in Bangladesh. We obtained annually reported, district-level aggregated malaria case data and information about disbursed funds from the NMCP. We used a Poisson regression model to examine the associations between total malaria, severe malaria, malaria-attributable mortality, and insecticide-treated net coverage. We identified and mapped malaria hotspots using the Getis-Ord Gi* statistic. We estimated the cost-effectiveness of the NMCP by estimating the cost per confirmed case, cost per treated case, and cost per person of insecticide-treated net coverage. During the study period (from Jan 1, 2008, to Dec 31, 2012) there were 285,731 confirmed malaria cases. Malaria decreased from 6.2 cases per 1000 population in 2008, to 2.1 cases per 1000 population in 2012. Prevalence of all malaria decreased by 65% (95% CI 65-66), severe malaria decreased by 79% (78-80), and malaria-associated mortality decreased by 91% (83-95). By 2012, there was one insecticide-treated net for every 2.6 individuals (SD 0.20). Districts with more than 0.5 insecticide-treated nets per person had a decrease in prevalence of 21% (95% CI 19-23) for all malaria, 25% (17-32) for severe malaria, and 76% (35-91) for malaria-associated mortality among all age groups. Malaria hotspots remained in the highly endemic districts in the Chittagong Hill Tracts. The cost per diagnosed case was US$0.39 (SD 0.02) and per treated case was $0.51 (0.27); $0.05 (0.04) was invested per person per year for health education and $0.68 (0.30) was spent per person per year for insecticide-treated net coverage. Malaria elimination is an achievable prospect in Bangladesh and failure to push for elimination nearly ensures a resurgence of disease. Consistent financing is needed to avoid resurgence and maintain elimination goals. None.

Malaria treatment, compliance and cure in Gandhinagar, Gujarat

Early diagnosis and complete treatment are the most important components of the malaria control program, which have a direct bearing on prevention of mortality and reduction in the morbidity, therefore, follow-up of the patient treatment is an important aspect of monitoring disease in the community. Aims: To assess treatment compliance among confirmed malaria cases in Gandhinagar District and to determine the proportion of cure rate with complete treatment as per the national drug policy. Study Variables: Exploratory-rural and urban areas; outcome-compliance, cure rate. Analysis: Percentage, proportions. Results: Compliance among 192 subjects under the study conducted in 2008 i.e. confirmed that malaria cases were 88% even after the introduction of 14 day therapy for “Plasmodium vivax” cases, while 100% cure rate was observed on the follow-up till the 28th day among “P. vivax” and “P. falciparum” cases which helped in reducing malaria incidence in the rural area by 50% as compared to the preceding year of the study. Conclusion: Follow-up of the treatment given to malaria patients has enhanced compliance and cure rate, which in turn contributed towards interruption of transmission. Therefore, a better cure rate through the administration of effective antimalarial drugs as per the drug policy in combination with other containment measures is the right strategy to keep morbidity and mortality due to malaria under effective control.

Climate Variability and Malaria Transmission �C Fogera District, Ethiopia, 2003-2011

Background: Epidemic malaria creates serious public health emergencies in Ethiopia. Malaria transmission rates have been linked to temperature and precipitation; factors that will be affected by increasing climate variability. Method: We analyzed climate and malaria data from January 2003-December 2011 in Fogera district of Ethiopia. We compared monthly rainfall and temperature data with the number of confirmed malaria cases. Results: We identified 104,716 confirmed malaria cases, which were treated in the district from 2003-2011 (monthly cases range from 98 – 5038). The annual prevalence rate was 104 per 1000. Annual average rainfall was 1268 mm, and annually there were between four and six months with rainfall that exceeded 80mm. There was a trend associating months with rainfall above 80mm and higher rates of confirmed malaria cases in seven of the nine years of the study period. Average monthly temperatures throughout the nine years period ranged from 180c to 280c. Conclusions: Malaria still constitutes a serious public health problem in Fogera district. Monthly precipitation greater than 80 mm was associated with increased malaria transmission rates in the district, and temperature probably was not a limiting factor. We recommend the development of climate prediction models to help forecast and control malaria outbreaks in the district.

Performance and clinical usefulness of the Optimal-IT® test in the treatment of confirmed malaria cases in rural areas in Côte d'Ivoire.

In Africa, malaria care is mostly based on clinical presumption and the general application of antimalarial treatment to all febrile episodes over several years. Treatment limited to confirmed cases might curb the practice of equating fever with malaria, antimalarial drug abuse and the extension of Plasmodium resistance, provided that powerful and reliable rapid diagnostic tests are used. This study aimed at determining the performances of the Optimal-IT® test in the strategy for the exclusive treatment of uncomplicated malaria in rural areas. A prospective study conducted in the forest region of San Pedro, Côte d'Ivoire, included patients exhibiting clinical signs of uncomplicated malaria who gave their consent and benefited from thick blood film (TBF), blood smear (BS) and Optimal-IT® (pLDH-based) test. Rapid diagnostic test (RDT) results were taken into consideration to decide on malaria treatment and then compared with TBF/BS results (reference) to assess the performances and clinical usefulness of the RDT. The mean age of the 384 patients included (209 men, 175 women) was 28 years and the mean temperature was 38.1°C. TBF/BS and Optimal-IT® were concordant in 92% of patients but discordant in 10 false negative (3%) and 19 false-positive patients (5%). The average parasite density of P. falciparum was 25,600 trophozoites/μl. The performances calculated were: sensitivity=95%, specificity=91%, positive predictive value=90%, negative predictive value=95%, positive likelihood ratio=10, negative likelihood ratio=0.06 and diagnostic odds ratio=166, indicating that Optimal-IT® is a powerful and credible diagnostic tool. The 193 RDT-positive patients treated were healed, despite three recurrence cases at day (D) D17, D25 and D27, respectively. RDT-negative patients received various treatments (antibiotics, paracetamol), but two patients among them presented with a bout of malaria on D7. None of the previously untreated patients returned with severe malaria. The Optimal-IT® test, which is already used in the field, showed good performances to effectively detect patients with and without malaria. It is therefore adapted to the malaria treatment strategy limited to confirmed cases.

Malaria Outbreak Investigation in Mecha, Dera and Fogera Districts, Amhara Region, Ethiopia

Introduction- Malaria is caused by the protozoan parasite plasmodium and transmitted by anopheles mosquitoes. It remains the major public health challenge in Amhara region. Mecha, Dera and Fogera are some of the malaria endemic districts of the region. The aim of this study was to investigate the outbreak and guide intervention measures. Methods – Descriptive cross sectional investigation of malaria outbreak was conducted. We used health facility records of malaria data and entomological survey. We discussed with health extension workers and available morbidity, mortality and diagnostic data was collected. We surveyed households for clinical malaria cases and utilization of LLINs and its status, the condition of IRS operation at household level was observed. Results-In Midre-Genet kebele/village the prevalence rate of malaria in the 4th week of April was 3 per 1000(19) population and reached to 37 per 1000(226) population in the 2nd week of May 2012.The attack rate was 82.5 per 1000(67) population in under-fives and 82.6 per 1000(429) population in >5 years old. In Wotet-Ber kebele the prevalence rate of malaria increased to 5 per 1000(35) population in the 1st week of May 2012 and became 22 per 1000 (150) population in the 2nd week of May. The attack rate was 30.4 per 1000(28) population in under-fives and 42.9 per 1000(253) population in >5 years old. In Zemene-Hiwot kebele/village the prevalence rate of malaria increased to 4.5 per 1000 (45) population in the 1st week of May 2012 and became 17 per 1000(171) population in the 3rd week of May 2012. The attack rate was 82.6 per 1000(111) population in under-fives and 36.3 per 1000(312) in >5 years old.In Hamusit cluster the number of confirmed malaria cases surpass the threshold starting from December 2011. Attack rate was 8.9 per 1000(559) population in December 2011 and became 14.7 per 1000(919) population in April 2012. In Aba Kiros kebele prevalence rate of malaria increased in the 2nd week of May 2012 1.2(8) and reached to 14.9(93) per 1000 population in the 1st week of June 2012. Vector control interventions were not done in all affected villages/kebeles. Conclusion- There were multiple breeding sites where the larvae of anopheles mosquitoes found and vector control interventions were not carried out timely. There was no weekly monitoring chart at districts and health facilities to detect increased malaria cases at an early stage.