Reductions in malaria and anaemia case and death burden at hospitals following scale-up of malaria control in Zanzibar, 1999-2008

MW Aregawi, AS Ali, AW Al-Mafazy, F Molteni, S Katikiti, M Warsame, RJA Njau, R Komatsu, E Korenromp, M Hosseini, D Low-Beer, A Bjorkman, U D'Alessandro, M Coosemans, M Otten

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    BACKGROUND: In Zanzibar, the Ministry of Health and partners accelerated malaria control from September 2003 onwards. The impact of the scale-up of insecticide-treated nets (ITN), indoor-residual spraying (IRS) and artemisinin-combination therapy (ACT) combined on malaria burden was assessed at six out of seven in-patient health facilities. METHODS: Numbers of outpatient and inpatient cases and deaths were compared between 2008 and the pre-intervention period 1999-2003. Reductions were estimated by segmented log-linear regression, adjusting the effect size for time trends during the pre-intervention period. RESULTS: In 2008, for all age groups combined, malaria deaths had fallen by an estimated 90% (95% confidence interval 55-98%)(p<0.025), malaria in-patient cases by 78% (48-90%), and parasitologically-confirmed malaria out-patient cases by 99.5% (92-99.9%). Anaemia in-patient cases decreased by 87% (57-96%); anaemia deaths and out-patient cases declined without reaching statistical significance due to small numbers. Reductions were similar for children under-five and older ages. Among under-fives, the proportion of all-cause deaths due to malaria fell from 46% in 1999-2003 to 12% in 2008 (p<0.01) and that for anaemia from 26% to 4% (p<0.01). Cases and deaths due to other causes fluctuated or increased over 1999-2008, without consistent difference in the trend before and after 2003. CONCLUSIONS: Scaling-up effective malaria interventions reduced malaria-related burden at health facilities by over 75% within 5 years. In high-malaria settings, intensified malaria control can substantially contribute to reaching the Millennium Development Goal 4 target of reducing under-five mortality by two-thirds between 1990 and 2015.
    Original languageEnglish
    JournalMalaria Journal
    Issue number46
    Pages (from-to)1-9
    Number of pages9
    Publication statusPublished - 2011


    • B780-tropical-medicine
    • Protozoal diseases
    • Malaria
    • Plasmodium falciparum
    • National programs
    • Control programs
    • Impregnated bednets
    • Insecticides
    • Residual spraying
    • Artemisinin combination therapies (ACT)
    • ACT
    • Hospitalization
    • Outpatients
    • Mortality rates
    • Mortality reduction
    • Survival
    • Anemia
    • Children
    • Health impact
    • Efficiency
    • Zanzibar
    • Tanzania
    • Africa-East


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