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Changes in malaria indices between 1999 and 2007 in The Gambia: a retrospective analysis.

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 - Lancet (2008)

Bottom Line: We obtained additional data from single sites for haemoglobin concentrations in paediatric admissions and for age distribution of malaria admissions.From 2003 to 2007, at four sites with complete slide examination records, the proportions of malaria-positive slides decreased by 82% (3397/10861 in 2003 to 337/6142 in 2007), 85% (137/1259 to 6/368), 73% (3664/16932 to 666/11333), and 50% (1206/3304 to 336/1853).Since 2004, mean haemoglobin concentrations for all-cause admissions increased by 12 g/L (85 g/L in 2000-04 to 97 g/L in 2005-07), and mean age of paediatric malaria admissions increased from 3.9 years (95% CI 3.7-4.0) to 5.6 years (5.0-6.2).

View Article: PubMed Central - PubMed

Affiliation: Medical Research Council Laboratories, Fajara, Banjul, The Gambia.

ABSTRACT

Background: Malaria is a major cause of morbidity and mortality in Africa. International effort and funding for control has been stepped up, with substantial increases from 2003 in the delivery of malaria interventions to pregnant women and children younger than 5 years in The Gambia. We investigated the changes in malaria indices in this country, and the causes and public-health significance of these changes.

Methods: We undertook a retrospective analysis of original records to establish numbers and proportions of malaria inpatients, deaths, and blood-slide examinations at one hospital over 9 years (January, 1999-December, 2007), and at four health facilities in three different administrative regions over 7 years (January, 2001-December, 2007). We obtained additional data from single sites for haemoglobin concentrations in paediatric admissions and for age distribution of malaria admissions.

Findings: From 2003 to 2007, at four sites with complete slide examination records, the proportions of malaria-positive slides decreased by 82% (3397/10861 in 2003 to 337/6142 in 2007), 85% (137/1259 to 6/368), 73% (3664/16932 to 666/11333), and 50% (1206/3304 to 336/1853). At three sites with complete admission records, the proportions of malaria admissions fell by 74% (435/2530 to 69/1531), 69% (797/2824 to 89/1032), and 27% (2204/4056 to 496/1251). Proportions of deaths attributed to malaria in two hospitals decreased by 100% (seven of 115 in 2003 to none of 117 in 2007) and 90% (22/122 in 2003 to one of 58 in 2007). Since 2004, mean haemoglobin concentrations for all-cause admissions increased by 12 g/L (85 g/L in 2000-04 to 97 g/L in 2005-07), and mean age of paediatric malaria admissions increased from 3.9 years (95% CI 3.7-4.0) to 5.6 years (5.0-6.2).

Interpretation: A large proportion of the malaria burden has been alleviated in The Gambia. Our results encourage consideration of a policy to eliminate malaria as a public-health problem, while emphasising the importance of accurate and continuous surveillance.

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Location of the five sites studied for hospital admissions, inpatient deaths, and laboratory slide microscopy in The GambiaThe facilities at Fajara and Brikama serve mostly urban and peri-urban communities in the most densely populated part of the country near the coast; Farafenni is a small town with a large hospital serving a predominantly rural population; and facilities at Sibanor and Keneba are in large villages serving surrounding rural communities.
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fig1: Location of the five sites studied for hospital admissions, inpatient deaths, and laboratory slide microscopy in The GambiaThe facilities at Fajara and Brikama serve mostly urban and peri-urban communities in the most densely populated part of the country near the coast; Farafenni is a small town with a large hospital serving a predominantly rural population; and facilities at Sibanor and Keneba are in large villages serving surrounding rural communities.

Mentions: The Gambia is situated on the Atlantic coast of west Africa at the interface of the Sudan Savannah and northern Guinea Savannah zones. The country has one short rainy season from June to October, and most malaria transmission occurs between August and December.23 Almost all clinical cases of malaria are due to Plasmodium falciparum, which is transmitted by three species of the Anopheles gambiae complex.24 Patterns of malaria in three of the five different administrative regions of The Gambia have been surveyed at five health facilities, in which we identified high quality and continuous records (figure 1). In the Western Region, we obtained data for three facilities: Medical Research Council (MRC) hospital in Fajara (ward admissions, deaths, and outpatient haematology laboratory data); WEC (Worldwide Evangelisation for Christ) mission hospital in Sibanor (ward admissions, number of blood transfusions, haemoglobin concentration, and deaths); and the Government Major Health Centre in Brikama (haematology laboratory data). In the Lower River Region, we obtained laboratory haematology data from the MRC Keneba Clinic that serves the surrounding villages. In the North Bank Region, we gathered records for paediatric ward admissions and haematology laboratory data from the AFPRC (Armed Forces Provisional Ruling Council) District Hospital in Farafenni, which is the second largest hospital in the country.


Changes in malaria indices between 1999 and 2007 in The Gambia: a retrospective analysis.

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 - Lancet (2008)

Location of the five sites studied for hospital admissions, inpatient deaths, and laboratory slide microscopy in The GambiaThe facilities at Fajara and Brikama serve mostly urban and peri-urban communities in the most densely populated part of the country near the coast; Farafenni is a small town with a large hospital serving a predominantly rural population; and facilities at Sibanor and Keneba are in large villages serving surrounding rural communities.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2607025&req=5

fig1: Location of the five sites studied for hospital admissions, inpatient deaths, and laboratory slide microscopy in The GambiaThe facilities at Fajara and Brikama serve mostly urban and peri-urban communities in the most densely populated part of the country near the coast; Farafenni is a small town with a large hospital serving a predominantly rural population; and facilities at Sibanor and Keneba are in large villages serving surrounding rural communities.
Mentions: The Gambia is situated on the Atlantic coast of west Africa at the interface of the Sudan Savannah and northern Guinea Savannah zones. The country has one short rainy season from June to October, and most malaria transmission occurs between August and December.23 Almost all clinical cases of malaria are due to Plasmodium falciparum, which is transmitted by three species of the Anopheles gambiae complex.24 Patterns of malaria in three of the five different administrative regions of The Gambia have been surveyed at five health facilities, in which we identified high quality and continuous records (figure 1). In the Western Region, we obtained data for three facilities: Medical Research Council (MRC) hospital in Fajara (ward admissions, deaths, and outpatient haematology laboratory data); WEC (Worldwide Evangelisation for Christ) mission hospital in Sibanor (ward admissions, number of blood transfusions, haemoglobin concentration, and deaths); and the Government Major Health Centre in Brikama (haematology laboratory data). In the Lower River Region, we obtained laboratory haematology data from the MRC Keneba Clinic that serves the surrounding villages. In the North Bank Region, we gathered records for paediatric ward admissions and haematology laboratory data from the AFPRC (Armed Forces Provisional Ruling Council) District Hospital in Farafenni, which is the second largest hospital in the country.

Bottom Line: We obtained additional data from single sites for haemoglobin concentrations in paediatric admissions and for age distribution of malaria admissions.From 2003 to 2007, at four sites with complete slide examination records, the proportions of malaria-positive slides decreased by 82% (3397/10861 in 2003 to 337/6142 in 2007), 85% (137/1259 to 6/368), 73% (3664/16932 to 666/11333), and 50% (1206/3304 to 336/1853).Since 2004, mean haemoglobin concentrations for all-cause admissions increased by 12 g/L (85 g/L in 2000-04 to 97 g/L in 2005-07), and mean age of paediatric malaria admissions increased from 3.9 years (95% CI 3.7-4.0) to 5.6 years (5.0-6.2).

View Article: PubMed Central - PubMed

Affiliation: Medical Research Council Laboratories, Fajara, Banjul, The Gambia.

ABSTRACT

Background: Malaria is a major cause of morbidity and mortality in Africa. International effort and funding for control has been stepped up, with substantial increases from 2003 in the delivery of malaria interventions to pregnant women and children younger than 5 years in The Gambia. We investigated the changes in malaria indices in this country, and the causes and public-health significance of these changes.

Methods: We undertook a retrospective analysis of original records to establish numbers and proportions of malaria inpatients, deaths, and blood-slide examinations at one hospital over 9 years (January, 1999-December, 2007), and at four health facilities in three different administrative regions over 7 years (January, 2001-December, 2007). We obtained additional data from single sites for haemoglobin concentrations in paediatric admissions and for age distribution of malaria admissions.

Findings: From 2003 to 2007, at four sites with complete slide examination records, the proportions of malaria-positive slides decreased by 82% (3397/10861 in 2003 to 337/6142 in 2007), 85% (137/1259 to 6/368), 73% (3664/16932 to 666/11333), and 50% (1206/3304 to 336/1853). At three sites with complete admission records, the proportions of malaria admissions fell by 74% (435/2530 to 69/1531), 69% (797/2824 to 89/1032), and 27% (2204/4056 to 496/1251). Proportions of deaths attributed to malaria in two hospitals decreased by 100% (seven of 115 in 2003 to none of 117 in 2007) and 90% (22/122 in 2003 to one of 58 in 2007). Since 2004, mean haemoglobin concentrations for all-cause admissions increased by 12 g/L (85 g/L in 2000-04 to 97 g/L in 2005-07), and mean age of paediatric malaria admissions increased from 3.9 years (95% CI 3.7-4.0) to 5.6 years (5.0-6.2).

Interpretation: A large proportion of the malaria burden has been alleviated in The Gambia. Our results encourage consideration of a policy to eliminate malaria as a public-health problem, while emphasising the importance of accurate and continuous surveillance.

Show MeSH
Related in: MedlinePlus