Impact of national malaria control scale-up programmes in Africa: magnitude and attribution of effects

Abstract

BackgroundSince 2005, malaria control scale-up has progressed in many African countries. Controlled studies of insecticide-treated mosquito nets (ITNs), indoor residual spraying (IRS), intermittent preventive treatment during pregnancy (IPTp) and malaria case management suggested that when incorporated into national programmes a dramatic health impact, likely more than a 20% decrease in all-cause childhood mortality, was possible. To assess the extent to which national malaria programmes are achieving impact the authors reviewed African country programme data available through 2009.MethodsNational survey data, published literature, and organization or country reports produced during 2000-2009 were reviewed to assess available malaria financing, intervention delivery, household or target population coverage, and reported health benefits including infection, illness, severe anaemia, and death.ResultsBy the end of 2009, reports were available for ITN household ownership (n = 34) and IPTp use (n = 27) in malaria-endemic countries in Africa, with at least two estimates (pre-2005 and post-2005 intervals). Information linking IRS and case management coverage to impact were more limited. There was generally at least a three-fold increase in household ITN ownership across these countries between pre-2005 (median of 2.4% of households with at least one ITN) and post-2005 (median of 32.5% of households with at least one ITN). Ten countries had temporal data to assess programme impact, and all reported progress on at least one impact indicator (typically on mortality); in under-five year mortality rates most observed a decline of more than 20%. The causal relationship between malaria programme scale-up and reduced child illness and mortality rates is supported by biologic plausibility including mortality declines consistent with experience from intervention efficacy trials, consistency of findings across multiple countries and different epidemiologic settings, and temporal congruity where morbidity and mortality declines have been documented in the 18 to 36 months following intervention scale-up.ConclusionsSeveral factors potentially have contributed to recent health improvement in African countries, but there is substantial evidence that achieving high malaria control intervention coverage, especially with ITNs and targeted IRS, has been the leading contributor to reduced child mortality. The documented impact provides the evidence required to support a global commitment to the expansion and long-term investment in malaria control to sustain and increase the health impact that malaria control is producing in Africa.

Enhancing Malaria Prevention in Cameroon Through Community Participation: An in-Depth Review

“…[41] These caused Cameroon to be ranked lowest of 29 African countries in ITN ownership and to feature among African countries with little or no progress in malaria prevention after ITN scale-up. [32,42] Despite the fact that 37% malaria infection occur in rural compared to 21% in urban areas, [43] access to ITN in the rural communities is very limited due to non-availability, [11,44] creating inequity and inequality. There is therefore little information on social perception and malaria prevention situation in rural communities, [4] leading to low national ownership of 36%, with only 21% of under-fives sleeping under an ITN.…”

Impact, Challenges, and Future Projections of Vaccine Trials in Africa

“…This finding is more evident in malaria studies in which the close follow-up results in disappearance of severe disease, making it difficult to be studied as an outcome measure. 13 Infrastructure development and capacity building. Most clinical trials require the use of equipment that may not otherwise be available in the community/research institute, especially in settings that were not initially designed for clinical trials.…”

High Levels of Antibodies to Multiple Domains and Strains of VAR2CSA Correlate with the Absence of Placental Malaria in Cameroonian Women Living in an Area of High Plasmodium falciparum Transmission

“…Furthermore, babies born to mothers who have placental malaria are more likely to have clinical malaria earlier in life than babies born to placentalmalaria-negative (PM Ϫ ) mothers (11,27,49). Despite relentless efforts against malaria, children younger than 5 years of age in sub-Saharan Africa still account for the majority of malaria-related deaths worldwide (16,52,56). Thus, preventing malaria in pregnant women is important, not only to reduce maternal morbidity but also to minimize the negative impact of malaria on the health of young children.…”