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01.12.2012 | Research | Ausgabe 1/2012 Open Access

Malaria Journal 1/2012

Trends in malaria cases, hospital admissions and deaths following scale-up of anti-malarial interventions, 2000–2010, Rwanda

Malaria Journal > Ausgabe 1/2012
Corine Karema, 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
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1475-2875-11-236) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

MA and CK carried out the study design, data collection, analysis and drafting and overall coordination of writing up-of the paper. AR, AK, MM helped in data collection and editing; and field supervision. SF and KG helped in reviewing the paper and programme interventions in Rwanda. RW helped in data management and analysis. ML and RC helped in reviewing the manuscript. RN provided overall technical guide and reviewed the paper. NF, JN, DN and IU participated in the data collection, analysis and review of the paper. AB provided guidance on the objectives of the study, study design, interpretation of results and reviewed of the paper. All authors read and approved the final manuscript.



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.


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.


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.


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.
Additional file 1: Table S1. Percentage change in laboratory confirmed malaria cases, inpatient cases and deaths in 2010 compared to pre-intervention period (2000–2005) in hospitals and potential proprtion of population protected by ITN, Rwanda, 2000-2010. (PDF 168 KB)
Additional file 2: Table S2. Percentage change in malaria and non-malaria indicators in post intervention years (2006-2010) compared to pre-intervention period (2000–2005), for all ages and <5 years, in 30 of the 40 hospitals, Rwanda, 2000-2010. (PDF 187 KB)
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