The online version of this article (doi:10.1186/1475-2875-11-389) contains supplementary material, which is available to authorized users.
Authors declare that there is no conflict of interest.
DEL participated to the study design, undertook the field study, conducted the data collection, analysis and interpretation, and wrote the manuscript. PT was involved in the study design, supervised data collection and participated in data analysis. BS was involved in the data collection, analysis and interpretation and revised the manuscript. KST was involved in the study design, data analysis and interpretation and revised the manuscript. SG and PW participated in data analysis and interpretation of results, in writing and reviewing the manuscript and provided comments on the manuscript. C de Jager was responsible for the conception of the study and its overall scientific management, for analysis and interpretation, and the preparation of the final manuscript. All the authors have read and approved the final manuscript to be submitted for publication.
In 2004, Togo adopted a regional strategy for malaria control that made use of insecticide-treated nets (ITNs), followed by the use of rapid diagnostic tests (RDTs), artemisinin-based combination therapy (ACT). Community health workers (CHWs) became involved in 2007. In 2010, the impact of the implementation of these new malaria control strategies had not yet been evaluated. This study sought to assess the trends of malaria incidence and mortality due to malaria in Est Mono district from 2005 to 2010.
Secondary data on confirmed and suspected malaria cases reported by health facilities from 2005 to 2010 were obtained from the district health information system. Rainfall and temperature data were provided by the national Department of Meteorology. Chi square test or independent student’s t-test were used to compare trends of variables at a 95% confidence interval. An interrupted time series analysis was performed to assess the effect of meteorological factors and the use of ACT and CHWs on morbidity and mortality due to malaria.
From January 2005 to December 2010, 114,654 malaria cases (annual mean 19,109 ± 6,622) were reported with an increase of all malaria cases from 10,299 in 2005 to 26,678 cases in 2010 (p<0.001). Of the 114,654 malaria cases 52,539 (45.8%) were confirmed cases. The prevalence of confirmed malaria cases increased from 23.1 per 1,000 in 2005 to 257.5 per 1,000 population in 2010 (p <0.001). The mortality rate decreased from 7.2 per 10,000 in 2005 to 3.6 per 10,000 in 2010 (p <0.001), with a significant reduction of 43.9% of annual number of death due to malaria. Rainfall (β-coefficient = 1.6; p = 0.05) and number of CHWs trained (β-coefficient = 6.8; p = 0.002) were found to be positively correlated with malaria prevalence.
This study showed an increase of malaria prevalence despite the implementation of the use of ACT and CHW strategies. Multicentre data analysis over longer periods should be carried out in similar settings to assess the impact of malaria control strategies on the burden of the disease. Integrated malaria vector control management should be implemented in Togo to reduce malaria transmission.
World Health Organization: World Malaria Report. 2010, Geneva, Switzerland: WHO
Ministère de la Santé: Plan stratégique national du Togo "Faire reculer le paludisme" 2006–2010. 2006, Lomé, Togo: Programme National de Lutte contre le Paludisme
Nyarango PM, Gebremeskel T, Mebrahtu G, Mufunda J, Abdulmumini U, Ogbamariam A, Kosia A, Gebremichael A, Gunawardena D, Ghebrat Y, Okbaldet Y: A steep decline of malaria morbidity and mortality trends in Eritrea between 2000 and 2004: the effect of combination of control methods. Malar J. 2006, 5: 33-10.1186/1475-2875-5-33. PubMedCentralCrossRefPubMed
Ministère de la santé: Plan de développement sanitaire 2008–2012. 2008, Elavagnon, Togo: District de l'Est Mono
Monti K, Koch GG, Sawyer J: Institute of Statistics Mimeo Series vol. 1200. An application of segmented linear regression models to the analysis of data from a cross-sectional growth experiment. 1978, Chapel Hill: University of North Carolina
Ministère de la Santé: Plan stratégique 2011–2015 de lutte contre le paludisme au Togo. 2011, Lomé, Togo: Programme National de Lutte contre le Paludisme
Burgert CR, Bigogo G, Adazu K, Odhiambo F, Buehler J, Breiman RF, Laserson K, Hamel MJ, Feikin DR: Impact of implementation of free high-quality health care on health facility attendance by sick children in rural western Kenya. Trop Med Int Health. 2011, 16: 711-720. 10.1111/j.1365-3156.2011.02752.x. CrossRefPubMed
Roca-Feltrer A, Kwizombe CJ, Sanjoaquin MA, Sesay SS, Faragher B, Harrison J, Geukers K, Kabuluzi S, Mathanga DP, Molyneux E, Chagomera M, Taylor T, Molyneux M, Heyderman RS: Lack of decline in childhood malaria, Malawi, 2001–2010. Emerg Infect Dis. 2012, 18: 272-278. 10.3201/eid1802.111008. PubMedCentralCrossRefPubMed
terKuile FO, Terlouw DJ, Phillips-Howard PA, Hawley WA, Friedman JF, Kolczak MS, Kariuki SK, Shi YP, Kwena AM, Vulule JM, Nahlen BL: Impact of permethrin-treated bed nets on malaria and all-cause morbidity in young children in an area of intense perennial malaria transmission in western Kenya: cross-sectional survey. AmJTrop Med Hyg. 2003, 68: 100-107.
Kleinschmidt I, Schwabe C, Shiva M, Segura JL, Sima V, Mabunda SJ, Coleman M: Combining indoor residual spraying and insecticide-treated net interventions. AmJTrop Med Hyg. 2009, 81: 519-524.
Bhattarai A, Ali AS, Kachur SP, Martensson A, Abbas AK, Khatib R, Al-Mafazy AW, Ramsan M, Rotllant G, Gerstenmaier JF, Molteni F, Abdulla S, Montgomery SM, Kaneko A, Björkman A: Impact of artemisinin-based combination therapy and insecticide-treated nets on malaria burden in Zanzibar. PLoS Med. 2007, 4: e309-10.1371/journal.pmed.0040309. PubMedCentralCrossRefPubMed
Barnes KI, Durrheim DN, Little F, Jackson A, Mehta U, Allen E, Dlamini SS, Tsoka J, Bredenkamp B, Mthembu DJ, White NJ, Sharp BL: Effect of artemether-lumefantrine policy and improved vector control on malaria burden in KwaZulu-Natal South Africa. PLoS Med. 2005, 2: e330-10.1371/journal.pmed.0020330. PubMedCentralCrossRefPubMed
Smith SC, Joshi UB, Grabowsky M, Selanikio J, Nobiya T, Aapore T: Evaluation of bednets after 38 months of household use in northwest Ghana. AmJTrop Med Hyg. 2007, 77: 243-248.
- Morbidity and mortality due to malaria in Est Mono district, Togo, from 2005 to 2010: a times series analysis
Essoya D Landoh
Khin S Tint
Sheba N Gitta
Christiaan de Jager
- BioMed Central
Neu im Fachgebiet Innere Medizin
Meistgelesene Bücher aus der Inneren Medizin
Mail Icon II