Impact of artemisinin-based combination therapy and insecticide-treated nets on malaria burden in Zanzibar.

<h4>Background</h4>The Roll Back Malaria strategy recommends a combination of interventions for malaria control. Zanzibar implemented artemisinin-based combination therapy (ACT) for uncomplicated malaria in late 2003 and long-lasting insecticidal nets (LLINs) from early 2006. ACT is prov...

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Autores principales:	Achuyt Bhattarai, Abdullah S Ali, S Patrick Kachur, Andreas Mårtensson, Ali K Abbas, Rashid Khatib, Abdul-Wahiyd Al-Mafazy, Mahdi Ramsan, Guida Rotllant, Jan F Gerstenmaier, Fabrizio Molteni, Salim Abdulla, Scott M Montgomery, Akira Kaneko, Anders Björkman
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2007
Materias:	Medicine R
Acceso en línea:	https://doaj.org/article/8523391e8a2d4fdf99d72da6c42c8c0d
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spelling	oai:doaj.org-article:8523391e8a2d4fdf99d72da6c42c8c0d2021-11-25T05:36:43ZImpact of artemisinin-based combination therapy and insecticide-treated nets on malaria burden in Zanzibar.1549-12771549-167610.1371/journal.pmed.0040309https://doaj.org/article/8523391e8a2d4fdf99d72da6c42c8c0d2007-11-01T00:00:00Zhttps://doi.org/10.1371/journal.pmed.0040309https://doaj.org/toc/1549-1277https://doaj.org/toc/1549-1676<h4>Background</h4>The Roll Back Malaria strategy recommends a combination of interventions for malaria control. Zanzibar implemented artemisinin-based combination therapy (ACT) for uncomplicated malaria in late 2003 and long-lasting insecticidal nets (LLINs) from early 2006. ACT is provided free of charge to all malaria patients, while LLINs are distributed free to children under age 5 y ("under five") and pregnant women. We investigated temporal trends in Plasmodium falciparum prevalence and malaria-related health parameters following the implementation of these two malaria control interventions in Zanzibar.<h4>Methods and findings</h4>Cross-sectional clinical and parasitological surveys in children under the age of 14 y were conducted in North A District in May 2003, 2005, and 2006. Survey data were analyzed in a logistic regression model and adjusted for complex sampling design and potential confounders. Records from all 13 public health facilities in North A District were analyzed for malaria-related outpatient visits and admissions. Mortality and demographic data were obtained from District Commissioner's Office. P. falciparum prevalence decreased in children under five between 2003 and 2006; using 2003 as the reference year, odds ratios (ORs) and 95% confidence intervals (CIs) were, for 2005, 0.55 (0.28-1.08), and for 2006, 0.03 (0.00-0.27); p for trend < 0.001. Between 2002 and 2005 crude under-five, infant (under age 1 y), and child (aged 1-4 y) mortality decreased by 52%, 33%, and 71%, respectively. Similarly, malaria-related admissions, blood transfusions, and malaria-attributed mortality decreased significantly by 77%, 67% and 75%, respectively, between 2002 and 2005 in children under five. Climatic conditions favorable for malaria transmission persisted throughout the observational period.<h4>Conclusions</h4>Following deployment of ACT in Zanzibar 2003, malaria-associated morbidity and mortality decreased dramatically within two years. Additional distribution of LLINs in early 2006 resulted in a 10-fold reduction of malaria parasite prevalence. The results indicate that the Millennium Development Goals of reducing mortality in children under five and alleviating the burden of malaria are achievable in tropical Africa with high coverage of combined malaria control interventions.Achuyt BhattaraiAbdullah S AliS Patrick KachurAndreas MårtenssonAli K AbbasRashid KhatibAbdul-Wahiyd Al-MafazyMahdi RamsanGuida RotllantJan F GerstenmaierFabrizio MolteniSalim AbdullaScott M MontgomeryAkira KanekoAnders BjörkmanPublic Library of Science (PLoS)articleMedicineRENPLoS Medicine, Vol 4, Iss 11, p e309 (2007)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R
spellingShingle	Medicine R Achuyt Bhattarai Abdullah S Ali S Patrick Kachur Andreas Mårtensson Ali K Abbas Rashid Khatib Abdul-Wahiyd Al-Mafazy Mahdi Ramsan Guida Rotllant Jan F Gerstenmaier Fabrizio Molteni Salim Abdulla Scott M Montgomery Akira Kaneko Anders Björkman Impact of artemisinin-based combination therapy and insecticide-treated nets on malaria burden in Zanzibar.
description	<h4>Background</h4>The Roll Back Malaria strategy recommends a combination of interventions for malaria control. Zanzibar implemented artemisinin-based combination therapy (ACT) for uncomplicated malaria in late 2003 and long-lasting insecticidal nets (LLINs) from early 2006. ACT is provided free of charge to all malaria patients, while LLINs are distributed free to children under age 5 y ("under five") and pregnant women. We investigated temporal trends in Plasmodium falciparum prevalence and malaria-related health parameters following the implementation of these two malaria control interventions in Zanzibar.<h4>Methods and findings</h4>Cross-sectional clinical and parasitological surveys in children under the age of 14 y were conducted in North A District in May 2003, 2005, and 2006. Survey data were analyzed in a logistic regression model and adjusted for complex sampling design and potential confounders. Records from all 13 public health facilities in North A District were analyzed for malaria-related outpatient visits and admissions. Mortality and demographic data were obtained from District Commissioner's Office. P. falciparum prevalence decreased in children under five between 2003 and 2006; using 2003 as the reference year, odds ratios (ORs) and 95% confidence intervals (CIs) were, for 2005, 0.55 (0.28-1.08), and for 2006, 0.03 (0.00-0.27); p for trend < 0.001. Between 2002 and 2005 crude under-five, infant (under age 1 y), and child (aged 1-4 y) mortality decreased by 52%, 33%, and 71%, respectively. Similarly, malaria-related admissions, blood transfusions, and malaria-attributed mortality decreased significantly by 77%, 67% and 75%, respectively, between 2002 and 2005 in children under five. Climatic conditions favorable for malaria transmission persisted throughout the observational period.<h4>Conclusions</h4>Following deployment of ACT in Zanzibar 2003, malaria-associated morbidity and mortality decreased dramatically within two years. Additional distribution of LLINs in early 2006 resulted in a 10-fold reduction of malaria parasite prevalence. The results indicate that the Millennium Development Goals of reducing mortality in children under five and alleviating the burden of malaria are achievable in tropical Africa with high coverage of combined malaria control interventions.
format	article
author	Achuyt Bhattarai Abdullah S Ali S Patrick Kachur Andreas Mårtensson Ali K Abbas Rashid Khatib Abdul-Wahiyd Al-Mafazy Mahdi Ramsan Guida Rotllant Jan F Gerstenmaier Fabrizio Molteni Salim Abdulla Scott M Montgomery Akira Kaneko Anders Björkman
author_facet	Achuyt Bhattarai Abdullah S Ali S Patrick Kachur Andreas Mårtensson Ali K Abbas Rashid Khatib Abdul-Wahiyd Al-Mafazy Mahdi Ramsan Guida Rotllant Jan F Gerstenmaier Fabrizio Molteni Salim Abdulla Scott M Montgomery Akira Kaneko Anders Björkman
author_sort	Achuyt Bhattarai
title	Impact of artemisinin-based combination therapy and insecticide-treated nets on malaria burden in Zanzibar.
title_short	Impact of artemisinin-based combination therapy and insecticide-treated nets on malaria burden in Zanzibar.
title_full	Impact of artemisinin-based combination therapy and insecticide-treated nets on malaria burden in Zanzibar.
title_fullStr	Impact of artemisinin-based combination therapy and insecticide-treated nets on malaria burden in Zanzibar.
title_full_unstemmed	Impact of artemisinin-based combination therapy and insecticide-treated nets on malaria burden in Zanzibar.
title_sort	impact of artemisinin-based combination therapy and insecticide-treated nets on malaria burden in zanzibar.
publisher	Public Library of Science (PLoS)
publishDate	2007
url	https://doaj.org/article/8523391e8a2d4fdf99d72da6c42c8c0d
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Impact of artemisinin-based combination therapy and insecticide-treated nets on malaria burden in Zanzibar.

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