Trends in malaria cases, hospital admissions and deaths following scale-up of anti-malarial interventions, 2000-2010, Rwanda - PubMed (original) (raw)
doi: 10.1186/1475-2875-11-236.
Maru W Aregawi, Alphonse Rukundo, Alain Kabayiza, Monique Mulindahabi, Ibrahima S Fall, Khoti Gausi, Ryan O Williams, Michael Lynch, Richard Cibulskis, Ngabo Fidele, Jean-Pierre Nyemazi, Daniel Ngamije, Irenee Umulisa, Robert Newman, Agnes Binagwaho
Affiliations
- PMID: 22823945
- PMCID: PMC3502144
- DOI: 10.1186/1475-2875-11-236
Trends in malaria cases, hospital admissions and deaths following scale-up of anti-malarial interventions, 2000-2010, Rwanda
Corine Karema et al. Malar J. 2012.
Abstract
Background: To control malaria, the Rwandan government and its partners distributed insecticide-treated nets (ITN) and made artemisinin-based combination therapy (ACT) widely available from 2005 onwards. The impact of these interventions on malaria cases, admissions and deaths was assessed using data from district hospitals and household surveys.
Methods: District records of ITN and ACT distribution were reviewed. Malaria and non-malaria indictors in 30 district hospitals were ascertained from surveillance records. Trends in cases, admissions and deaths for 2000 to 2010 were assessed by segmented log-linear regression, adjusting the effect size for time trends during the pre-intervention period, 2000-2005. Changes were estimated by comparing trends in post-intervention (2006-2010) with that of pre-intervention (2000-2005) period. All-cause deaths in children under-five in household surveys of 2005 and 2010 were also reviewed to corroborate with the trends of deaths observed in hospitals.
Results: The proportion of the population potentially protected by ITN increased from nearly zero in 2005 to 38% in 2006, and 76% in 2010; no major health facility stock-outs of ACT were recorded following their introduction in 2006. In district hospitals, after falling during 2006-2008, confirmed malaria cases increased in 2009 coinciding with decreased potential ITN coverage and declined again in 2010 following an ITN distribution campaign. For all age groups, from the pre-intervention period, microscopically confirmed cases declined by 72%, (95% Confidence Interval [CI], 12-91%) in 2010, slide positivity rate declined 58%, (CI, 47%-68%), malaria inpatient cases declined 76% (CI, 49%-88%); and malaria deaths declined 47% (CI, 47%-81%). In children below five years of age, malaria inpatients decreased 82% (CI, 61%-92%) and malaria hospital deaths decreased 77% (CI, 40%-91%). Concurrently, outpatient cases, admissions and deaths due to non-malaria diseases in all age groups either increased or remained unchanged. Rainfall and temperature remained favourable for malaria transmission. The annual all-cause mortality in children under-five in household surveys declined from 152 per 1,000 live births during 2001-2005, to 76 per 1,000 live births in 2006-2010 (55% decline). The five-year cumulative number of all-cause deaths in hospital declined 28% (8,051 to 5,801) during the same period.
Conclusions: A greater than 50% decline in confirmed malaria cases, admissions and deaths at district hospitals in Rwanda since 2005 followed a marked increase in ITN coverage and use of ACT. The decline occurred among both children under-five and in those five years and above, while hospital utilization increased and suitable conditions for malaria transmission persisted. Declines in malaria indicators in children under 5 years were more striking than in the older age groups. The resurgence in cases associated with decreased ITN coverage in 2009 highlights the need for sustained high levels of anti-malarial interventions in Rwanda and other malaria endemic countries.
Figures
Figure 1
Trends of malaria cases and deaths by age group, slide positivity rate in district hospitals and timing of interventions, 2000–2010, Rwanda.
Figure 2
Confirmed malaria cases, non-malaria outpatient cases, number of cases tested and slide positivity rate in all ages, 30 hospitals, 2000–2010, Rwanda.
Figure 3
Inpatient malaria and non-malaria cases and deaths in 30 hospitals by age, 2000–2010, Rwanda.
Figure 4
Trends on monthly slide positivity rate in hospitals, health centers, and rainfall, 2000–2010, Rwanda.
Figure 5
Trends in average confirmed malaria case/1,000 and slide positivity rate in hospitals and LLIN coverage, by East and other provinces, 2000–2010 Rwanda.
Figure 6
Trends on average malaria admissions/1,000, malaria deaths/100,000 in hospitals and LLIN coverage, by East and other provinces, 2000–2010, Rwanda.
Figure 7
Slide positivity rate and malaria admission rate by district during pre- and post-intervention period, 2000-2010, Rwanda.
Figure 8
Trends in under-five child mortality (in population surveys, DHS2000, 2005, 2010), all-cause under-five child mortality and malaria deaths in hospitals (n = 30), 2000–2010, Rwanda.
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