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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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Related in: MedlinePlus

Monthly numbers (left panel) and yearly proportions (right panel) of malaria hospital admissions (A), deaths (B), and positive slides in outpatients (C) at the MRC in Fajara from January, 1999, to December, 2007Monthly and yearly rainfall in the Greater Banjul Area over the period is also shown (D). Error bars indicate 95% CIs.
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fig2: Monthly numbers (left panel) and yearly proportions (right panel) of malaria hospital admissions (A), deaths (B), and positive slides in outpatients (C) at the MRC in Fajara from January, 1999, to December, 2007Monthly and yearly rainfall in the Greater Banjul Area over the period is also shown (D). Error bars indicate 95% CIs.

Mentions: During the 9 years from January, 1999, to December, 2007, 21 820 patients were admitted to the MRC hospital in Fajara, 1341 inpatients died, and 129 397 slides were examined at the outpatient haematology laboratory. Every year, the number of admissions attributed to malaria, deaths attributed to malaria, and positive slides showed a highly seasonal distribution, with a peak from September to November at the end of the rainy season and with few cases during the driest months of the year (figure 2). During the study period, we detected a substantial decrease in the yearly number of admissions and deaths attributed to malaria and malaria-positive slides, particularly since 2003 (figure 2). 2002 had an unusually low yearly rainfall and a low number of cases of malaria, which is a normal pattern of inter-year variation, but the reduction since 2003 was not related to any decrease in yearly rainfall (figure 2).


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)

Monthly numbers (left panel) and yearly proportions (right panel) of malaria hospital admissions (A), deaths (B), and positive slides in outpatients (C) at the MRC in Fajara from January, 1999, to December, 2007Monthly and yearly rainfall in the Greater Banjul Area over the period is also shown (D). Error bars indicate 95% CIs.
© Copyright Policy
Related In: Results  -  Collection

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

fig2: Monthly numbers (left panel) and yearly proportions (right panel) of malaria hospital admissions (A), deaths (B), and positive slides in outpatients (C) at the MRC in Fajara from January, 1999, to December, 2007Monthly and yearly rainfall in the Greater Banjul Area over the period is also shown (D). Error bars indicate 95% CIs.
Mentions: During the 9 years from January, 1999, to December, 2007, 21 820 patients were admitted to the MRC hospital in Fajara, 1341 inpatients died, and 129 397 slides were examined at the outpatient haematology laboratory. Every year, the number of admissions attributed to malaria, deaths attributed to malaria, and positive slides showed a highly seasonal distribution, with a peak from September to November at the end of the rainy season and with few cases during the driest months of the year (figure 2). During the study period, we detected a substantial decrease in the yearly number of admissions and deaths attributed to malaria and malaria-positive slides, particularly since 2003 (figure 2). 2002 had an unusually low yearly rainfall and a low number of cases of malaria, which is a normal pattern of inter-year variation, but the reduction since 2003 was not related to any decrease in yearly rainfall (figure 2).

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