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Nationwide evaluation of malaria infections, morbidity, mortality, and coverage of malaria control interventions in Madagascar.

Kesteman T, Randrianarivelojosia M, Mattern C, Raboanary E, Pourette D, Girond F, Raharimanga V, Randrianasolo L, Piola P, Rogier C - Malar. J. (2014)

Bottom Line: Parasite rate (PR) as measured by rapid diagnostic tests was 3.1%, and was significantly higher in five to 19 year olds, in males, poorer socio-economic status (SES) quintiles and rural areas.This study provides valuable data for the evaluation of effectiveness and factors affecting MCI.MCI and evaluation surveys should consider the whole population and not only focus on under-fives and pregnant women in pre-elimination or elimination strategies.

View Article: PubMed Central - PubMed

Affiliation: Malaria Research Unit, Institut Pasteur de Madagascar, BP 1274 Avaradoha, Antananarivo 101, Madagascar. thomask@pasteur.mg.

ABSTRACT

Background: In the last decade, an important scale-up was observed in malaria control interventions. Madagascar entered the process for pre-elimination in 2007. Policy making needs operational indicators, but also indicators about effectiveness and impact of malaria control interventions (MCI). This study is aimed at providing data about malaria infection, morbidity, and mortality, and MCI in Madagascar.

Methods: Two nationwide surveys were simultaneously conducted in 2012-2013 in Madagascar: a study about non-complicated clinical malaria cases in 31 sentinel health facilities, and a cross-sectional survey (CSS) in 62 sites. The CSS encompassed interviews, collection of biological samples and verbal autopsies (VA). Data from CSS were weighted for age, sex, malaria transmission pattern, and population density. VA data were processed with InterVA-4 software.

Results: CSS included 15,746 individuals of all ages. Parasite rate (PR) as measured by rapid diagnostic tests was 3.1%, and was significantly higher in five to 19 year olds, in males, poorer socio-economic status (SES) quintiles and rural areas. Long-lasting insecticidal nets (LLIN) use was 41.7% and was significantly lower in five to 19 year olds, males and wealthier SES quintiles. Proportion of persons covered by indoor residual spraying (IRS) was 66.8% in targeted zones. Proportion of persons using other insecticides than IRS was 22.8%. Coverage of intermittent preventive treatment during pregnancy was 21.5%. Exposure to information, education and communication messages about malaria was significantly higher in wealthier SES for all media but information meetings. The proportion of fever case managements considered as appropriate with regard to malaria was 15.8%. Malaria was attributed as the cause of death in 14.0% of 86 VA, and 50% of these deaths involved persons above the age of five years. The clinical case study included 818 cases of which people above the age of five accounted for 79.7%. In targeted zones, coverage of LLIN and IRS were lower in clinical cases than in general population.

Conclusions: This study provides valuable data for the evaluation of effectiveness and factors affecting MCI. MCI and evaluation surveys should consider the whole population and not only focus on under-fives and pregnant women in pre-elimination or elimination strategies.

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Related in: MedlinePlus

Flow diagram of cross-sectional survey.
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Fig2: Flow diagram of cross-sectional survey.

Mentions: Overall, 4,356 households were selected at random for interview. In 325 (7.5%), the household remained vacant during the survey. In 455 of the 4,031 remaining (11.3%), the head of household or his representative refused to participate (Figure 2). In 388 (85.3%) of the refusals, a reason was reported; most cited reasons for refusal were: not having time (35.3%), blood sampling refusal without further explanations (24.5%), blood sampling refusal for religious or taboos (fady) reasons (16.8%), and feeling healthy (i.e., they “don’t need medical investigation” 16.5%). All households that declined to participate were replaced with other households randomly selected from the same hamlet.Figure 2


Nationwide evaluation of malaria infections, morbidity, mortality, and coverage of malaria control interventions in Madagascar.

Kesteman T, Randrianarivelojosia M, Mattern C, Raboanary E, Pourette D, Girond F, Raharimanga V, Randrianasolo L, Piola P, Rogier C - Malar. J. (2014)

Flow diagram of cross-sectional survey.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4289287&req=5

Fig2: Flow diagram of cross-sectional survey.
Mentions: Overall, 4,356 households were selected at random for interview. In 325 (7.5%), the household remained vacant during the survey. In 455 of the 4,031 remaining (11.3%), the head of household or his representative refused to participate (Figure 2). In 388 (85.3%) of the refusals, a reason was reported; most cited reasons for refusal were: not having time (35.3%), blood sampling refusal without further explanations (24.5%), blood sampling refusal for religious or taboos (fady) reasons (16.8%), and feeling healthy (i.e., they “don’t need medical investigation” 16.5%). All households that declined to participate were replaced with other households randomly selected from the same hamlet.Figure 2

Bottom Line: Parasite rate (PR) as measured by rapid diagnostic tests was 3.1%, and was significantly higher in five to 19 year olds, in males, poorer socio-economic status (SES) quintiles and rural areas.This study provides valuable data for the evaluation of effectiveness and factors affecting MCI.MCI and evaluation surveys should consider the whole population and not only focus on under-fives and pregnant women in pre-elimination or elimination strategies.

View Article: PubMed Central - PubMed

Affiliation: Malaria Research Unit, Institut Pasteur de Madagascar, BP 1274 Avaradoha, Antananarivo 101, Madagascar. thomask@pasteur.mg.

ABSTRACT

Background: In the last decade, an important scale-up was observed in malaria control interventions. Madagascar entered the process for pre-elimination in 2007. Policy making needs operational indicators, but also indicators about effectiveness and impact of malaria control interventions (MCI). This study is aimed at providing data about malaria infection, morbidity, and mortality, and MCI in Madagascar.

Methods: Two nationwide surveys were simultaneously conducted in 2012-2013 in Madagascar: a study about non-complicated clinical malaria cases in 31 sentinel health facilities, and a cross-sectional survey (CSS) in 62 sites. The CSS encompassed interviews, collection of biological samples and verbal autopsies (VA). Data from CSS were weighted for age, sex, malaria transmission pattern, and population density. VA data were processed with InterVA-4 software.

Results: CSS included 15,746 individuals of all ages. Parasite rate (PR) as measured by rapid diagnostic tests was 3.1%, and was significantly higher in five to 19 year olds, in males, poorer socio-economic status (SES) quintiles and rural areas. Long-lasting insecticidal nets (LLIN) use was 41.7% and was significantly lower in five to 19 year olds, males and wealthier SES quintiles. Proportion of persons covered by indoor residual spraying (IRS) was 66.8% in targeted zones. Proportion of persons using other insecticides than IRS was 22.8%. Coverage of intermittent preventive treatment during pregnancy was 21.5%. Exposure to information, education and communication messages about malaria was significantly higher in wealthier SES for all media but information meetings. The proportion of fever case managements considered as appropriate with regard to malaria was 15.8%. Malaria was attributed as the cause of death in 14.0% of 86 VA, and 50% of these deaths involved persons above the age of five years. The clinical case study included 818 cases of which people above the age of five accounted for 79.7%. In targeted zones, coverage of LLIN and IRS were lower in clinical cases than in general population.

Conclusions: This study provides valuable data for the evaluation of effectiveness and factors affecting MCI. MCI and evaluation surveys should consider the whole population and not only focus on under-fives and pregnant women in pre-elimination or elimination strategies.

Show MeSH
Related in: MedlinePlus