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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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Effect of survey type on change in anaemia and parasitaemia between 2005 and 2008*. *adjusted for age, ethnicity, wealth, clinical malaria (in the case of anaemia), current fever (for parasitaemia), district, and whether or not the child had slept under an ITN the previous night.
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Figure 4: Effect of survey type on change in anaemia and parasitaemia between 2005 and 2008*. *adjusted for age, ethnicity, wealth, clinical malaria (in the case of anaemia), current fever (for parasitaemia), district, and whether or not the child had slept under an ITN the previous night.

Mentions: Table 4 shows results of both unadjusted and adjusted logistic regression analyses of the association of anaemia and parasitaemia with type of survey (HH vs. EPI-HF) and year (2005 vs. 2008). Overall, there was no significant effect of type of survey on measured change in anaemia or parasitaemia over the 3 years. Adjusted analyses revealed that the odds of having anaemia in the 2008 HH survey was 0.74 (95% CI: 0.59-0.94) times that of the 2005 HH survey. The odds of having anaemia in the 2008 EPI-HF survey was 0.85 (95% CI: 0.65-1.12) times that of the 2005 EPI-HF survey. The reduction in the odds of having parasitaemia were even more pronounced and not significantly different between the two types of surveys (HH survey: 0.40 (95% CI: 0.3-0.52), EPI-HF survey: 0.31 (95% CI: 0.22-0.46)) (Figure 4).


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)

Effect of survey type on change in anaemia and parasitaemia between 2005 and 2008*. *adjusted for age, ethnicity, wealth, clinical malaria (in the case of anaemia), current fever (for parasitaemia), district, and whether or not the child had slept under an ITN the previous night.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Effect of survey type on change in anaemia and parasitaemia between 2005 and 2008*. *adjusted for age, ethnicity, wealth, clinical malaria (in the case of anaemia), current fever (for parasitaemia), district, and whether or not the child had slept under an ITN the previous night.
Mentions: Table 4 shows results of both unadjusted and adjusted logistic regression analyses of the association of anaemia and parasitaemia with type of survey (HH vs. EPI-HF) and year (2005 vs. 2008). Overall, there was no significant effect of type of survey on measured change in anaemia or parasitaemia over the 3 years. Adjusted analyses revealed that the odds of having anaemia in the 2008 HH survey was 0.74 (95% CI: 0.59-0.94) times that of the 2005 HH survey. The odds of having anaemia in the 2008 EPI-HF survey was 0.85 (95% CI: 0.65-1.12) times that of the 2005 EPI-HF survey. The reduction in the odds of having parasitaemia were even more pronounced and not significantly different between the two types of surveys (HH survey: 0.40 (95% CI: 0.3-0.52), EPI-HF survey: 0.31 (95% CI: 0.22-0.46)) (Figure 4).

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