The online version of this article (doi:10.1186/1475-2875-11-236) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
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)12936_2012_2489_MOESM1_ESM.pdf
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)12936_2012_2489_MOESM2_ESM.pdf
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WHO: World malaria report 2011. 2011, World Health Organization, Geneva
United Nations, United Nations Population Division: World population prospects. 2011, New York, http://esa.un.org/wpp/unpp/panel_population.htm,
Otten M, Aregawi M, Were W, Karema C, Medh in A, Bekele W, Jima D, Gausi K, Komatsu R, Korenromp E, Low-Beer D, Grabowsky M: Initial evidence of reduction of malaria cases and deaths in Rwanda and Ethiopia due to rapid scale-up of malaria prevention and treatment. Malar J. 2009, 8: 14-10.1186/1475-2875-8-14. PubMedCentralCrossRefPubMed
Office National de la Population: Rwanda Demographic and Health Survey. 2000, ORC Macro, 11785 Beltsville Drive, Calverton, MD 20705, USA
Institut National de la Statistique: Rwanda: Rwanda Demographic and Health Survey, 2005. 2005, ORC Macro, Calverton, Maryland, USA, July 2006
Box GEP, Jenkins GM: Time series analysis: forecasting and control. 1976, Holden-Day, San Francisco
McDowall D, McCleary R, Meidinger EE, Hay RA: Interrupted time series analysis. 1980, Sage Publications, Beverly Hills, CA, USA
National Institute of Statistics of Rwanda: Rwanda Interim Demographic and Health Survey 2007–08. 2009, ICF Macro Calverton, Maryland, USA, http://www.measuredhs.com/pubs/pdf/FR215/FR215.pdf,
National Institute of Statistics of Rwanda: Rwanda Demographic and Health Survey 2010 (2010 RDHS). ICF International. 2012, NISR, MOH, and ICF International, Calverton, Maryland, USA
Roll Back Malaria Partnership: The global malaria action plan, for a malaria free world. 2008, Geneva, Switzerland, http://www.rbm.who.int/gmap/index.html. Accessed 12 November 2008
Rwagacondo CE, Niyitegeka F, Sarushi J, Karema C, Mugisha V, Dujardin JC, Van Overmeir C, van den Ende J, D’Alessandro U: Efficacy of amodiaquine alone and combined with sulfadoxine-pyrimethamine and of sulfadoxine pyrimethamine combined with artesunate. AmJTrop Med Hyg. 2003, 68: 743-747.
Fanelloa CI, Karema C, van Dorend W, Van Overmeir C, Ngamije D, D’Alessandro U: A randomised trial to assess the safety and efficacy of artemether– lumefantrine (Coartem®) for the treatment of uncomplicated Plasmodium falciparum malaria in Rwanda. Trans R Soc Trop Med Hyg. 2007, 101: 344-350. 10.1016/j.trstmh.2006.06.010. CrossRef
Aregawi MW, Ali AS, Al-mafazy AW, Molteni F, Katikiti S, Warsame M, Njau RJ, Komatsu R, Korenromp E, Hosseini M, Low-Beer D, Bjorkman A, D’Alessandro U, Coosemans M, Otten M: Reductions in malaria and anaemia case and death burden at hospitals following scale-up of malaria control in Zanzibar, 1999–2008. Malar J. 2011, 10: 46-10.1186/1475-2875-10-46. PubMedCentralCrossRefPubMed
Ceesay SJ, Casals-Pascual C, Erskine J, Anya SE, Duah NO, Fulford AJ, Sesay SS, Abubakar I, Dunyo S, Sey O, Palmer A, Fofana M, Corrah T, Bojang KA, Whittle HC, Greenwood BM, Conway DJ: Changes in malaria indices between 1999 and 2007 in The Gambia: a retrospective analysis. Lancet. 2008, 372: 1545-1554. 10.1016/S0140-6736(08)61654-2. PubMedCentralCrossRefPubMed
Teklehaimanot HD, Teklehaimanot A, Kiszewski A, Rampao HS, Sachs JD: Malaria in São Tomé and Principe: on the brink of elimination after three years of effective antimalarial measures. AmJTrop Med Hyg. 2009, 80: 133-140.
Kleinschmidt I, Schwabe C, Benavente L, Torrez M, Ridl FC, Segura JL, Ehmer P, Nchama GN: Marked increase in child survival after four years of intensive malaria control. AmJTrop Med Hyg. 2009, 80: 882-888.
Chizema-Kawesha E, Miller JM, Steketee RW, Mukonka VM, Mukuka C, Mohamed AD, Miti SK, Campbell CC: Scaling up malaria control in Zambia: progress and impact 2005–2008. AmJTrop Med Hyg. 2010, 83: 480-488. CrossRef
Government of the Republic of Zambia, Ministry of Health: Zambia National Malaria Indicator Survey 2010. 2010, Ministry of Health, Government of the Republic of Zambia
- Trends in malaria cases, hospital admissions and deaths following scale-up of anti-malarial interventions, 2000–2010, Rwanda
Maru W Aregawi
Ibrahima S Fall
Ryan O Williams
- BioMed Central
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