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The decline in paediatric malaria admissions on the coast of Kenya.

Okiro EA, Hay SI, Gikandi PW, Sharif SK, Noor AM, Peshu N, Marsh K, Snow RW - Malar. J. (2007)

Bottom Line: Paediatric admission data were assembled over 8.25 years from three District Hospitals; Kilifi, Msambweni and Malindi, situated along the Kenyan Coast.This trend was observed against a background of rising or constant non-malaria admissions and unaffected by long-term rainfall throughout the surveillance period.This study provides evidence of a changing disease burden on the Kenyan coast and that the most parsimonious explanation is an expansion in the coverage of interventions such as the use of insecticide-treated nets and the availability of anti-malarial medicines.

View Article: PubMed Central - HTML - PubMed

Affiliation: Malaria Public Health & Epidemiology Group, Centre for Geographic Medicine Research - Coast, Kenya Medical Research Institute/Wellcome Trust Research Programme, P,O, Box 43640, 00100 GPO, Nairobi, Kenya. eokiro@nairobi.kemri-wellcome.org

ABSTRACT

Background: There is only limited information on the health impact of expanded coverage of malaria control and preventative strategies in Africa.

Methods: Paediatric admission data were assembled over 8.25 years from three District Hospitals; Kilifi, Msambweni and Malindi, situated along the Kenyan Coast. Trends in monthly malaria admissions between January 1999 and March 2007 were analysed using several time-series models that adjusted for monthly non-malaria admission rates and the seasonality and trends in rainfall.

Results: Since January 1999 paediatric malaria admissions have significantly declined at all hospitals. This trend was observed against a background of rising or constant non-malaria admissions and unaffected by long-term rainfall throughout the surveillance period. By March 2007 the estimated proportional decline in malaria cases was 63% in Kilifi, 53% in Kwale and 28% in Malindi. Time-series models strongly suggest that the observed decline in malaria admissions was a result of malaria-specific control efforts in the hospital catchment areas.

Conclusion: This study provides evidence of a changing disease burden on the Kenyan coast and that the most parsimonious explanation is an expansion in the coverage of interventions such as the use of insecticide-treated nets and the availability of anti-malarial medicines. While specific attribution to intervention coverage cannot be computed what is clear is that this area of Kenya is experiencing a malaria epidemiological transition.

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Cumulative monthly ITN distribution volumes expressed per capita across the three districts of Malindi, Kilifi and Kwale.
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Figure 4: Cumulative monthly ITN distribution volumes expressed per capita across the three districts of Malindi, Kilifi and Kwale.

Mentions: There are several possible factors that might explain these observations and are considered as plausibility arguments, as proposed by Habicht [23] and Victora [24], rather than measurable correlates. The most notable programmatic change over the 8.25 years of surveillance has been the increasing use of ITNs [4]. We have assembled a population adjusted estimate of the per capita ITN distribution patterns between 1999 and 2007 across the three districts combined (Figure 4). At the start of the observation period ITN distribution in all the three study sites was negligible. During the period 2001–2004, there was a steady increase in the cumulative per capita ITN distribution (Figure 4). One year after initiation of a retail sector programme (beginning of 2003), cumulative ITN distribution was estimated to be 3% per capita across the three districts. By December 2004, three months after the inception of an MCH clinic sales programme, cumulative ITN distribution was over 13 nets per 100 people. The largest increase occurred in September 2006 during the mass distribution campaign from an estimated 0.34 nets per capita in August 2006 to 0.49 nets per capita by September 2006. Extending the surveillance from 2006 into March 2007 corresponds to a period of highest ITN "coverage", implementation of a new effective first line treatment policy and increasing rainfall. Even so the anomaly in malaria admissions recorded was greatest during this period with an average of -79 in Kilifi, -34 in Malindi and -14 in Kwale. It should, however, be recognized that the decrease in malaria cases started before the major expansion of prevention coverage in 2006, reasons for this remain unclear.


The decline in paediatric malaria admissions on the coast of Kenya.

Okiro EA, Hay SI, Gikandi PW, Sharif SK, Noor AM, Peshu N, Marsh K, Snow RW - Malar. J. (2007)

Cumulative monthly ITN distribution volumes expressed per capita across the three districts of Malindi, Kilifi and Kwale.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2194691&req=5

Figure 4: Cumulative monthly ITN distribution volumes expressed per capita across the three districts of Malindi, Kilifi and Kwale.
Mentions: There are several possible factors that might explain these observations and are considered as plausibility arguments, as proposed by Habicht [23] and Victora [24], rather than measurable correlates. The most notable programmatic change over the 8.25 years of surveillance has been the increasing use of ITNs [4]. We have assembled a population adjusted estimate of the per capita ITN distribution patterns between 1999 and 2007 across the three districts combined (Figure 4). At the start of the observation period ITN distribution in all the three study sites was negligible. During the period 2001–2004, there was a steady increase in the cumulative per capita ITN distribution (Figure 4). One year after initiation of a retail sector programme (beginning of 2003), cumulative ITN distribution was estimated to be 3% per capita across the three districts. By December 2004, three months after the inception of an MCH clinic sales programme, cumulative ITN distribution was over 13 nets per 100 people. The largest increase occurred in September 2006 during the mass distribution campaign from an estimated 0.34 nets per capita in August 2006 to 0.49 nets per capita by September 2006. Extending the surveillance from 2006 into March 2007 corresponds to a period of highest ITN "coverage", implementation of a new effective first line treatment policy and increasing rainfall. Even so the anomaly in malaria admissions recorded was greatest during this period with an average of -79 in Kilifi, -34 in Malindi and -14 in Kwale. It should, however, be recognized that the decrease in malaria cases started before the major expansion of prevention coverage in 2006, reasons for this remain unclear.

Bottom Line: Paediatric admission data were assembled over 8.25 years from three District Hospitals; Kilifi, Msambweni and Malindi, situated along the Kenyan Coast.This trend was observed against a background of rising or constant non-malaria admissions and unaffected by long-term rainfall throughout the surveillance period.This study provides evidence of a changing disease burden on the Kenyan coast and that the most parsimonious explanation is an expansion in the coverage of interventions such as the use of insecticide-treated nets and the availability of anti-malarial medicines.

View Article: PubMed Central - HTML - PubMed

Affiliation: Malaria Public Health & Epidemiology Group, Centre for Geographic Medicine Research - Coast, Kenya Medical Research Institute/Wellcome Trust Research Programme, P,O, Box 43640, 00100 GPO, Nairobi, Kenya. eokiro@nairobi.kemri-wellcome.org

ABSTRACT

Background: There is only limited information on the health impact of expanded coverage of malaria control and preventative strategies in Africa.

Methods: Paediatric admission data were assembled over 8.25 years from three District Hospitals; Kilifi, Msambweni and Malindi, situated along the Kenyan Coast. Trends in monthly malaria admissions between January 1999 and March 2007 were analysed using several time-series models that adjusted for monthly non-malaria admission rates and the seasonality and trends in rainfall.

Results: Since January 1999 paediatric malaria admissions have significantly declined at all hospitals. This trend was observed against a background of rising or constant non-malaria admissions and unaffected by long-term rainfall throughout the surveillance period. By March 2007 the estimated proportional decline in malaria cases was 63% in Kilifi, 53% in Kwale and 28% in Malindi. Time-series models strongly suggest that the observed decline in malaria admissions was a result of malaria-specific control efforts in the hospital catchment areas.

Conclusion: This study provides evidence of a changing disease burden on the Kenyan coast and that the most parsimonious explanation is an expansion in the coverage of interventions such as the use of insecticide-treated nets and the availability of anti-malarial medicines. While specific attribution to intervention coverage cannot be computed what is clear is that this area of Kenya is experiencing a malaria epidemiological transition.

Show MeSH
Related in: MedlinePlus