Date Published: September 27, 2017
Publisher: The American Society of Tropical Medicine and Hygiene
Author(s): Christine L. Hershey, Lia S. Florey, Doreen Ali, Adam Bennett, Misheck Luhanga, Don P. Mathanga, S. René Salgado, Carrie F. Nielsen, Peter Troell, Gomezgani Jenda, Yazoume Yé, Achuyt Bhattarai.
Malaria control intervention coverage increased nationwide in Malawi during 2000–2010. Trends in intervention coverage were assessed against trends in malaria parasite prevalence, severe anemia (hemoglobin < 8 g/dL), and all-cause mortality in children under 5 years of age (ACCM) using nationally representative household surveys. Associations between insecticide-treated net (ITN) ownership, malaria morbidity, and ACCM were also assessed. Household ITN ownership increased from 27.4% (95% confidence interval [CI] = 25.9–29.0) in 2004 to 56.8% (95% CI = 55.6–58.1) in 2010. Similarly intermittent preventive treatment during pregnancy coverage increased from 28.2% (95% CI = 26.7–29.8) in 2000 to 55.0% (95% CI = 53.4–56.6) in 2010. Malaria parasite prevalence decreased significantly from 60.5% (95% CI = 53.0–68.0) in 2001 to 20.4% (95% CI = 15.7–25.1) in 2009 in children aged 6–35 months. Severe anemia prevalence decreased from 20.4% (95% CI: 17.3–24.0) in 2004 to 13.1% (95% CI = 11.0–15.4) in 2010 in children aged 6–23 months. ACCM decreased 41%, from 188.6 deaths per 1,000 live births (95% CI = 179.1–198.0) during 1996–2000, to 112.1 deaths per 1,000 live births (95% CI = 105.8–118.5) during 2006–2010. When controlling for other covariates in random effects logistic regression models, household ITN ownership was protective against malaria parasitemia in children (odds ratio [OR] = 0.81, 95% CI = 0.72–0.92) and severe anemia (OR = 0.82, 95% CI = 0.72–0.94). After considering the magnitude of changes in malaria intervention coverage and nonmalaria factors, and given the contribution of malaria to all-cause mortality in malaria-endemic countries, the substantial increase in malaria control interventions likely improved child survival in Malawi during 2000–2010.
Malaria caused by Plasmodium falciparum is endemic throughout Malawi.1 Malaria transmission is stable with seasonal peaks related to the rainfall during November to April.2 The Ministry of Health (MoH) in Malawi reported that malaria accounted for 40% of all outpatient visits and 40% of hospital deaths in 2001, and was the cause of workforce losses (up to 25 days of work lost per year on average).3 Malaria was also the leading cause (39%) of hospital admissions in children less than 5 years of age.3
This evaluation found a 41% reduction in ACCM in Malawi during 2000–2010, substantial increases in household ITN ownership and use in children under five, reductions in malaria parasitemia and severe anemia, and insufficient changes in socioeconomic factors and other determinants known to influence child health to fully explain the decline in child mortality. Consequently, the evaluation indicates that malaria interventions contributed to the decline in ACCM in Malawi during 2000–2010. The association of individual ITN ownership with reduced odds of parasitemia and severe anemia further strengthens this conclusion.