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Comparison of anaemia and parasitaemia as indicators of malaria control in household and EPI-health facility surveys in Malawi.

Mathanga DP, Campbell CH, Vanden Eng J, Wolkon A, Bronzan RN, Malenga GJ, Ali D, Desai M - Malar. J. (2010)

Bottom Line: HH net ownership did not increase between the years (50.5% vs. 49.8%), but insecticide treated net (ITN) ownership increased modestly from 41.5% (95% CI: 37.2%-45.8%) in 2005 to 45.3% (95% CI: 42.6%-48.0%) in 2008.This modest increase in ITN use was associated with a decrease in moderate to severe anaemia (Hb <8 g/dl) from 18.4% (95% CI:14.9%-21.8%) in 2005 to 15.4% (13.2%-17.7%) in 2008, while parasitaemia, measured as positive-slide microscopy, decreased from 18.9% (95% CI:14.7%-23.2%) to 16.9% (95% CI:13.8%-20.0%), a relative reduction of 16% and 11%, respectively.In HF surveys, anaemia prevalence decreased from 18.3% (95% CI: 14.9%-21.7%) to 15.4% (95% CI: 12.7%-18.2%), while parasitaemia decreased from 30.6% (95% CI: 25.7%-35.5%) to 13.2% (95% CI: 10.6%-15.8%), a relative reduction of 15% and 57%, respectively.

View Article: PubMed Central - HTML - PubMed

Affiliation: Malaria Alert Centre, College of Medicine, University of Malawi, P/Bag 360, Blantyre 3, Malawi. dmathang@mac.medcol.mw

ABSTRACT

Background: The World Health Organization has recommended that anaemia be used as an additional indicator to monitor malaria burden at the community level as malaria interventions are nationally scaled up. To date, there are no published evaluations of this recommendation.

Methods: To evaluate this recommendation, a comparison of anaemia and parasitaemia among 6-30 month old children was made during two repeated cross-sectional household (HH) and health facility (HF) surveys in six districts across Malawi at baseline (2005) and in a follow-up survey (2008) after a scale up of malaria control interventions.

Results: HH net ownership did not increase between the years (50.5% vs. 49.8%), but insecticide treated net (ITN) ownership increased modestly from 41.5% (95% CI: 37.2%-45.8%) in 2005 to 45.3% (95% CI: 42.6%-48.0%) in 2008. ITN use by children 6-30 months old, who were living in HH with at least one net, increased from 73.6% (95% CI:68.2%-79.1%) to 80.0% (95% CI:75.9%-84.1%) over the three-year period. This modest increase in ITN use was associated with a decrease in moderate to severe anaemia (Hb <8 g/dl) from 18.4% (95% CI:14.9%-21.8%) in 2005 to 15.4% (13.2%-17.7%) in 2008, while parasitaemia, measured as positive-slide microscopy, decreased from 18.9% (95% CI:14.7%-23.2%) to 16.9% (95% CI:13.8%-20.0%), a relative reduction of 16% and 11%, respectively. In HF surveys, anaemia prevalence decreased from 18.3% (95% CI: 14.9%-21.7%) to 15.4% (95% CI: 12.7%-18.2%), while parasitaemia decreased from 30.6% (95% CI: 25.7%-35.5%) to 13.2% (95% CI: 10.6%-15.8%), a relative reduction of 15% and 57%, respectively.

Conclusion: Increasing access to effective malaria prevention was associated with a reduced burden of malaria in young Malawian children. Anaemia measured at the HF level at time of routine vaccination may be a good surrogate indicator for its measurement at the HH level in evaluating national malaria control programmes.

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Map of Malawi showing the 6 districts where the household survey in 2005 and 2008.
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Figure 1: Map of Malawi showing the 6 districts where the household survey in 2005 and 2008.

Mentions: The study consisted of two population based cross-sectional surveys conducted in six sentinel districts (Figure 1) across Malawi at baseline (April/May 2005) and follow-up (April/May 2008). The districts span the spectrum of malaria transmission intensity in Malawi, and each one is divided into enumeration areas (EAs), which generally range from 10-400 households. Both surveys were conducted at the end of the rainy season, when malaria-related anaemia reaches its peak. There were no significant differences in mean rainfall (previous 90 days) or maximum temperatures (previous 30 days) between the two survey periods. Each of the surveys had two components, a community-based household (HH) survey conducted in Blantyre, Mwanza, Phalombe, Chiradzulu, Lilongwe and Rumphi districts; and a health facility survey conducted at the EPI clinics (EPI-HF) in Blantyre, Lilongwe and Rumphi districts. In Malawi, the entire population is at risk of malaria and transmission is perennial peaking during the rainy season (November to April). Malaria is the leading cause of death and illness in under-five children and pregnant women [5]; infant and under-five mortality are estimated at 71/1,000 and 111/1,000 live births, respectively [6]. EPI coverage is >80% for targeted diseases [6].


Comparison of anaemia and parasitaemia as indicators of malaria control in household and EPI-health facility surveys in Malawi.

Mathanga DP, Campbell CH, Vanden Eng J, Wolkon A, Bronzan RN, Malenga GJ, Ali D, Desai M - Malar. J. (2010)

Map of Malawi showing the 6 districts where the household survey in 2005 and 2008.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2864286&req=5

Figure 1: Map of Malawi showing the 6 districts where the household survey in 2005 and 2008.
Mentions: The study consisted of two population based cross-sectional surveys conducted in six sentinel districts (Figure 1) across Malawi at baseline (April/May 2005) and follow-up (April/May 2008). The districts span the spectrum of malaria transmission intensity in Malawi, and each one is divided into enumeration areas (EAs), which generally range from 10-400 households. Both surveys were conducted at the end of the rainy season, when malaria-related anaemia reaches its peak. There were no significant differences in mean rainfall (previous 90 days) or maximum temperatures (previous 30 days) between the two survey periods. Each of the surveys had two components, a community-based household (HH) survey conducted in Blantyre, Mwanza, Phalombe, Chiradzulu, Lilongwe and Rumphi districts; and a health facility survey conducted at the EPI clinics (EPI-HF) in Blantyre, Lilongwe and Rumphi districts. In Malawi, the entire population is at risk of malaria and transmission is perennial peaking during the rainy season (November to April). Malaria is the leading cause of death and illness in under-five children and pregnant women [5]; infant and under-five mortality are estimated at 71/1,000 and 111/1,000 live births, respectively [6]. EPI coverage is >80% for targeted diseases [6].

Bottom Line: HH net ownership did not increase between the years (50.5% vs. 49.8%), but insecticide treated net (ITN) ownership increased modestly from 41.5% (95% CI: 37.2%-45.8%) in 2005 to 45.3% (95% CI: 42.6%-48.0%) in 2008.This modest increase in ITN use was associated with a decrease in moderate to severe anaemia (Hb <8 g/dl) from 18.4% (95% CI:14.9%-21.8%) in 2005 to 15.4% (13.2%-17.7%) in 2008, while parasitaemia, measured as positive-slide microscopy, decreased from 18.9% (95% CI:14.7%-23.2%) to 16.9% (95% CI:13.8%-20.0%), a relative reduction of 16% and 11%, respectively.In HF surveys, anaemia prevalence decreased from 18.3% (95% CI: 14.9%-21.7%) to 15.4% (95% CI: 12.7%-18.2%), while parasitaemia decreased from 30.6% (95% CI: 25.7%-35.5%) to 13.2% (95% CI: 10.6%-15.8%), a relative reduction of 15% and 57%, respectively.

View Article: PubMed Central - HTML - PubMed

Affiliation: Malaria Alert Centre, College of Medicine, University of Malawi, P/Bag 360, Blantyre 3, Malawi. dmathang@mac.medcol.mw

ABSTRACT

Background: The World Health Organization has recommended that anaemia be used as an additional indicator to monitor malaria burden at the community level as malaria interventions are nationally scaled up. To date, there are no published evaluations of this recommendation.

Methods: To evaluate this recommendation, a comparison of anaemia and parasitaemia among 6-30 month old children was made during two repeated cross-sectional household (HH) and health facility (HF) surveys in six districts across Malawi at baseline (2005) and in a follow-up survey (2008) after a scale up of malaria control interventions.

Results: HH net ownership did not increase between the years (50.5% vs. 49.8%), but insecticide treated net (ITN) ownership increased modestly from 41.5% (95% CI: 37.2%-45.8%) in 2005 to 45.3% (95% CI: 42.6%-48.0%) in 2008. ITN use by children 6-30 months old, who were living in HH with at least one net, increased from 73.6% (95% CI:68.2%-79.1%) to 80.0% (95% CI:75.9%-84.1%) over the three-year period. This modest increase in ITN use was associated with a decrease in moderate to severe anaemia (Hb <8 g/dl) from 18.4% (95% CI:14.9%-21.8%) in 2005 to 15.4% (13.2%-17.7%) in 2008, while parasitaemia, measured as positive-slide microscopy, decreased from 18.9% (95% CI:14.7%-23.2%) to 16.9% (95% CI:13.8%-20.0%), a relative reduction of 16% and 11%, respectively. In HF surveys, anaemia prevalence decreased from 18.3% (95% CI: 14.9%-21.7%) to 15.4% (95% CI: 12.7%-18.2%), while parasitaemia decreased from 30.6% (95% CI: 25.7%-35.5%) to 13.2% (95% CI: 10.6%-15.8%), a relative reduction of 15% and 57%, respectively.

Conclusion: Increasing access to effective malaria prevention was associated with a reduced burden of malaria in young Malawian children. Anaemia measured at the HF level at time of routine vaccination may be a good surrogate indicator for its measurement at the HH level in evaluating national malaria control programmes.

Show MeSH
Related in: MedlinePlus