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Traoré N, Singhal T, Millogo O, Sié A, Utzinger J, Vounatsou P. Relative effects of climate factors and malaria control interventions on changes of parasitaemia risk in Burkina Faso from 2014 to 2017/2018. BMC Infect Dis 2024; 24:166. [PMID: 38326750 PMCID: PMC10848559 DOI: 10.1186/s12879-024-08981-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 01/03/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND In Burkina Faso, the prevalence of malaria has decreased over the past two decades, following the scale-up of control interventions. The successful development of malaria parasites depends on several climatic factors. Intervention gains may be reversed by changes in climatic factors. In this study, we investigated the role of malaria control interventions and climatic factors in influencing changes in the risk of malaria parasitaemia. METHODS Bayesian logistic geostatistical models were fitted on Malaria Indicator Survey data from Burkina Faso obtained in 2014 and 2017/2018 to estimate the effects of malaria control interventions and climatic factors on the temporal changes of malaria parasite prevalence. Additionally, intervention effects were assessed at regional level, using a spatially varying coefficients model. RESULTS Temperature showed a statistically important negative association with the geographic distribution of parasitaemia prevalence in both surveys; however, the effects of insecticide-treated nets (ITNs) use was negative and statistically important only in 2017/2018. Overall, the estimated number of infected children under the age of 5 years decreased from 704,202 in 2014 to 290,189 in 2017/2018. The use of ITNs was related to the decline at national and regional level, but coverage with artemisinin-based combination therapy only at regional level. CONCLUSION Interventions contributed more than climatic factors to the observed change of parasitaemia risk in Burkina Faso during the period of 2014 to 2017/2018. Intervention effects varied in space. Longer time series analyses are warranted to determine the differential effect of a changing climate on malaria parasitaemia risk.
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Affiliation(s)
- Nafissatou Traoré
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, CH-4123, Allschwil, Switzerland
- University of Basel, Petersplatz 1, CH-4001, Basel, Switzerland
- Nouna Health Research Centre, National Institute of Public Health, BP 02, Nouna, Burkina Faso
| | - Taru Singhal
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, CH-4123, Allschwil, Switzerland
- University of Basel, Petersplatz 1, CH-4001, Basel, Switzerland
| | - Ourohiré Millogo
- Nouna Health Research Centre, National Institute of Public Health, BP 02, Nouna, Burkina Faso
- Institut de Recherche en Sciences de la Santé/Centre National de Recherche Scientifique et Technologique, 01 BP, 2779, Bobo-Dioulasso, Burkina Faso
| | - Ali Sié
- Nouna Health Research Centre, National Institute of Public Health, BP 02, Nouna, Burkina Faso
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, CH-4123, Allschwil, Switzerland
- University of Basel, Petersplatz 1, CH-4001, Basel, Switzerland
| | - Penelope Vounatsou
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, CH-4123, Allschwil, Switzerland.
- University of Basel, Petersplatz 1, CH-4001, Basel, Switzerland.
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The use of routine health facility data for micro-stratification of malaria risk in mainland Tanzania. Malar J 2022; 21:345. [DOI: 10.1186/s12936-022-04364-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/05/2022] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background
Current efforts to estimate the spatially diverse malaria burden in malaria-endemic countries largely involve the use of epidemiological modelling methods for describing temporal and spatial heterogeneity using sparse interpolated prevalence data from periodic cross-sectional surveys. However, more malaria-endemic countries are beginning to consider local routine data for this purpose. Nevertheless, routine information from health facilities (HFs) remains widely under-utilized despite improved data quality, including increased access to diagnostic testing and the adoption of the electronic District Health Information System (DHIS2). This paper describes the process undertaken in mainland Tanzania using routine data to develop a high-resolution, micro-stratification risk map to guide future malaria control efforts.
Methods
Combinations of various routine malariometric indicators collected from 7098 HFs were assembled across 3065 wards of mainland Tanzania for the period 2017–2019. The reported council-level prevalence classification in school children aged 5–16 years (PfPR5–16) was used as a benchmark to define four malaria risk groups. These groups were subsequently used to derive cut-offs for the routine indicators by minimizing misclassifications and maximizing overall agreement. The derived-cutoffs were converted into numbered scores and summed across the three indicators to allocate wards into their overall risk stratum.
Results
Of 3065 wards, 353 were assigned to the very low strata (10.5% of the total ward population), 717 to the low strata (28.6% of the population), 525 to the moderate strata (16.2% of the population), and 1470 to the high strata (39.8% of the population). The resulting micro-stratification revealed malaria risk heterogeneity within 80 councils and identified wards that would benefit from community-level focal interventions, such as community-case management, indoor residual spraying and larviciding.
Conclusion
The micro-stratification approach employed is simple and pragmatic, with potential to be easily adopted by the malaria programme in Tanzania. It makes use of available routine data that are rich in spatial resolution and that can be readily accessed allowing for a stratification of malaria risk below the council level. Such a framework is optimal for supporting evidence-based, decentralized malaria control planning, thereby improving the effectiveness and allocation efficiency of malaria control interventions.
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Alegana VA, Macharia PM, Muchiri S, Mumo E, Oyugi E, Kamau A, Chacky F, Thawer S, Molteni F, Rutazanna D, Maiteki-Sebuguzi C, Gonahasa S, Noor AM, Snow RW. Plasmodium falciparum parasite prevalence in East Africa: Updating data for malaria stratification. PLOS GLOBAL PUBLIC HEALTH 2021; 1:e0000014. [PMID: 35211700 PMCID: PMC7612417 DOI: 10.1371/journal.pgph.0000014] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 11/15/2021] [Indexed: 11/18/2022]
Abstract
The High Burden High Impact (HBHI) strategy for malaria encourages countries to use multiple sources of available data to define the sub-national vulnerabilities to malaria risk, including parasite prevalence. Here, a modelled estimate of Plasmodium falciparum from an updated assembly of community parasite survey data in Kenya, mainland Tanzania, and Uganda is presented and used to provide a more contemporary understanding of the sub-national malaria prevalence stratification across the sub-region for 2019. Malaria prevalence data from surveys undertaken between January 2010 and June 2020 were assembled form each of the three countries. Bayesian spatiotemporal model-based approaches were used to interpolate space-time data at fine spatial resolution adjusting for population, environmental and ecological covariates across the three countries. A total of 18,940 time-space age-standardised and microscopy-converted surveys were assembled of which 14,170 (74.8%) were identified after 2017. The estimated national population-adjusted posterior mean parasite prevalence was 4.7% (95% Bayesian Credible Interval 2.6-36.9) in Kenya, 10.6% (3.4-39.2) in mainland Tanzania, and 9.5% (4.0-48.3) in Uganda. In 2019, more than 12.7 million people resided in communities where parasite prevalence was predicted ≥ 30%, including 6.4%, 12.1% and 6.3% of Kenya, mainland Tanzania and Uganda populations, respectively. Conversely, areas that supported very low parasite prevalence (<1%) were inhabited by approximately 46.2 million people across the sub-region, or 52.2%, 26.7% and 10.4% of Kenya, mainland Tanzania and Uganda populations, respectively. In conclusion, parasite prevalence represents one of several data metrics for disease stratification at national and sub-national levels. To increase the use of this metric for decision making, there is a need to integrate other data layers on mortality related to malaria, malaria vector composition, insecticide resistance and bionomic, malaria care-seeking behaviour and current levels of unmet need of malaria interventions.
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Affiliation(s)
- Victor A. Alegana
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
- Geography and Environmental Science, University of Southampton, Southampton, United Kingdom
| | - Peter M. Macharia
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Health Informatics, Computing, and Statistics, Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
| | - Samuel Muchiri
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Eda Mumo
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Elvis Oyugi
- Division of National Malaria Programme, Ministry of Health, Nairobi, Kenya
| | - Alice Kamau
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Frank Chacky
- National Malaria Control Programme, Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Sumaiyya Thawer
- National Malaria Control Programme, Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Fabrizio Molteni
- National Malaria Control Programme, Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Damian Rutazanna
- National Malaria Control Division, Ministry of Health, Kampala, Uganda
| | - Catherine Maiteki-Sebuguzi
- National Malaria Control Division, Ministry of Health, Kampala, Uganda
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | - Abdisalan M. Noor
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Robert W. Snow
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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Musoke D, Namata C, Ndejjo R, Ssempebwa JC, Musoke MB. Integrated malaria prevention in rural communities in Uganda: a qualitative feasibility study for a randomised controlled trial. Pilot Feasibility Stud 2021; 7:155. [PMID: 34376257 PMCID: PMC8352755 DOI: 10.1186/s40814-021-00894-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/30/2021] [Indexed: 11/25/2022] Open
Abstract
Background A randomised controlled trial (RCT) on integrated malaria prevention, which advocates the use of several malaria prevention methods holistically, has been proposed. However, before conducting an RCT, it is recommended that a feasibility study is carried out to provide information to support the main study, particularly for such a complex intervention. Therefore, a feasibility study for an RCT on integrated malaria prevention in Uganda was conducted. Methods The qualitative study carried out in Wakiso District employed focus group discussions (FGDs) and key informant interviews (KIIs) to explore community willingness to participate in the RCT as well as assess stakeholder perspectives on the future study. The participants of the FGDs were community members, while the key informants were selected from malaria stakeholders including Ministry of Health officials, health practitioners, local leaders, district health team members, and community health workers (CHWs). Thematic analysis was employed with the support of NVivo. Results A total of 12 FGDs and 19 KIIs were conducted. Five main themes emerged from the study: malaria prevention practices related to integrated malaria prevention; preferred malaria prevention methods in the integrated approach; potential challenges of integrated malaria prevention; perspectives on the proposed RCT; and sustainability of integrated malaria prevention. Despite a few methods being employed holistically in the community, insecticide-treated nets were the most widely used and preferred method for malaria prevention mainly because they were provided free by the government. The main challenges in the integrated approach were the high cost of some methods such as house screening, and concerns about the potential side effects of insecticide-based methods such as indoor residual spraying. Participants expressed high willingness to participate in the RCT to promote the use of multiple methods in their households and community. Involvement of CHWs during implementation was proposed as a sustainability strategy for the RCT interventions. Conclusion There was high willingness to participate in the proposed RCT on integrated malaria prevention. However, high cost and perceived negative health effects from some methods were identified as potential challenges. The type of methods to be included as well as sustainability mechanisms needs to be considered during the design of the RCT.
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Affiliation(s)
- David Musoke
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Carol Namata
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rawlance Ndejjo
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - John C Ssempebwa
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Miph B Musoke
- Department of Applied Sciences, School of Sciences, Nkumba University, Entebbe, Uganda
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Ekusai-Sebatta D, Arinaitwe E, Mpimbaza A, Nankabirwa JI, Drakeley C, Rosenthal PJ, Staedke SG, Muyinda H. Challenges and opportunities for use of long-lasting insecticidal nets to prevent malaria during overnight travel in Uganda: a qualitative study. Malar J 2021; 20:283. [PMID: 34174892 PMCID: PMC8235645 DOI: 10.1186/s12936-021-03811-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Travel is a well-recognized risk factor for malaria. Within sub-Saharan Africa, travellers from areas of lower to higher transmission intensity are potentially at high risk of malaria. Long-lasting insecticidal nets (LLINs) are the primary tool for prevention of malaria, and their widespread use has contributed to substantial reductions in malaria burden. However, travellers often fail to use LLINs. To further explore the challenges and opportunities of using LLINs, travellers were interviewed in Uganda. METHODS In August and September 2019, 20 participants attending outpatient clinics at Naguru General Hospital in Kampala with a history of travel out of Kampala within the previous 60 days were purposively selected. Data were collected through in-depth interviews and analysed thematically using NVivo 12. RESULTS Of the 20 participants, 13 were male. Thirteen of the 20 participants tested positive for malaria by microscopy, and 5 reported using of LLINs during travel. The main reasons for travel were to attend social events (weddings, funerals, overnight prayers) and for work. travellers who attended social events reported using LLINs less commonly than those who travelled for work. Challenges to using LLINs during travel included: (1) limited access to LLINs; (2) challenges in planning ahead of travel; (3) lack of space or ability to hang LLINs while travelling; (4) impression that LLINs in lodging places were unhygienic; (5) cultural beliefs discouraging use of LLINs during social events; (6) participation in overnight ceremonies; and (7) doubts about efficacy of LLINs. Positive factors influencing use of LLINs during travel included knowledge regarding malaria prevention and good affordability and availability of LLINs. CONCLUSIONS Despite good traveller knowledge regarding malaria control measures, use of LLINs was limited. Use of LLINs in the prevention of malaria among travellers from low to high transmission settings needs to be prioritized. This calls for increased behaviour change oriented communication to improve traveller preparedness and consideration of use of repellents in situations where LLINs may not be feasible. The Uganda Ministry of Health and Malaria Control Division should use educational messages to increase awareness about the risks of getting malaria during overnight travel through the media. Truck drivers should be sensitized through their companies to use the available space at the back of the trucks for hanging nets and consider using pop-up nets.
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Affiliation(s)
| | - Emmanuel Arinaitwe
- Infectious Diseases Research Collaboration, Kampala, Uganda.,London School of Hygiene and Tropical Medicine, London, UK
| | - Arthur Mpimbaza
- Infectious Diseases Research Collaboration, Kampala, Uganda.,Child Health & Development Centre, Makerere University College of Health Sciences, Kampala, Uganda
| | - Joaniter I Nankabirwa
- Infectious Diseases Research Collaboration, Kampala, Uganda.,Department of Medicine, Makerere University, Kampala, Uganda
| | - Chris Drakeley
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | | | - Herbert Muyinda
- Child Health & Development Centre, Makerere University College of Health Sciences, Kampala, Uganda
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6
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Odhiambo JN, Kalinda C, Macharia PM, Snow RW, Sartorius B. Spatial and spatio-temporal methods for mapping malaria risk: a systematic review. BMJ Glob Health 2021; 5:bmjgh-2020-002919. [PMID: 33023880 PMCID: PMC7537142 DOI: 10.1136/bmjgh-2020-002919] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 08/23/2020] [Accepted: 08/24/2020] [Indexed: 12/21/2022] Open
Abstract
Background Approaches in malaria risk mapping continue to advance in scope with the advent of geostatistical techniques spanning both the spatial and temporal domains. A substantive review of the merits of the methods and covariates used to map malaria risk has not been undertaken. Therefore, this review aimed to systematically retrieve, summarise methods and examine covariates that have been used for mapping malaria risk in sub-Saharan Africa (SSA). Methods A systematic search of malaria risk mapping studies was conducted using PubMed, EBSCOhost, Web of Science and Scopus databases. The search was restricted to refereed studies published in English from January 1968 to April 2020. To ensure completeness, a manual search through the reference lists of selected studies was also undertaken. Two independent reviewers completed each of the review phases namely: identification of relevant studies based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, data extraction and methodological quality assessment using a validated scoring criterion. Results One hundred and seven studies met the inclusion criteria. The median quality score across studies was 12/16 (range: 7–16). Approximately half (44%) of the studies employed variable selection techniques prior to mapping with rainfall and temperature selected in over 50% of the studies. Malaria incidence (47%) and prevalence (35%) were the most commonly mapped outcomes, with Bayesian geostatistical models often (31%) the preferred approach to risk mapping. Additionally, 29% of the studies employed various spatial clustering methods to explore the geographical variation of malaria patterns, with Kulldorf scan statistic being the most common. Model validation was specified in 53 (50%) studies, with partitioning data into training and validation sets being the common approach. Conclusions Our review highlights the methodological diversity prominent in malaria risk mapping across SSA. To ensure reproducibility and quality science, best practices and transparent approaches should be adopted when selecting the statistical framework and covariates for malaria risk mapping. Findings underscore the need to periodically assess methods and covariates used in malaria risk mapping; to accommodate changes in data availability, data quality and innovation in statistical methodology.
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Affiliation(s)
| | - Chester Kalinda
- Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa.,Faculty of Agriculture and Natural Resources, University of Namibia, Windhoek, Namibia
| | - Peter M Macharia
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Robert W Snow
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Benn Sartorius
- Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa.,Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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Lee SA, Jarvis CI, Edmunds WJ, Economou T, Lowe R. Spatial connectivity in mosquito-borne disease models: a systematic review of methods and assumptions. J R Soc Interface 2021; 18:20210096. [PMID: 34034534 PMCID: PMC8150046 DOI: 10.1098/rsif.2021.0096] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 04/26/2021] [Indexed: 12/14/2022] Open
Abstract
Spatial connectivity plays an important role in mosquito-borne disease transmission. Connectivity can arise for many reasons, including shared environments, vector ecology and human movement. This systematic review synthesizes the spatial methods used to model mosquito-borne diseases, their spatial connectivity assumptions and the data used to inform spatial model components. We identified 248 papers eligible for inclusion. Most used statistical models (84.2%), although mechanistic are increasingly used. We identified 17 spatial models which used one of four methods (spatial covariates, local regression, random effects/fields and movement matrices). Over 80% of studies assumed that connectivity was distance-based despite this approach ignoring distant connections and potentially oversimplifying the process of transmission. Studies were more likely to assume connectivity was driven by human movement if the disease was transmitted by an Aedes mosquito. Connectivity arising from human movement was more commonly assumed in studies using a mechanistic model, likely influenced by a lack of statistical models able to account for these connections. Although models have been increasing in complexity, it is important to select the most appropriate, parsimonious model available based on the research question, disease transmission process, the spatial scale and availability of data, and the way spatial connectivity is assumed to occur.
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Affiliation(s)
- Sophie A. Lee
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Christopher I. Jarvis
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - W. John Edmunds
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Rachel Lowe
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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8
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Korzeniewski K, Bylicka-Szczepanowska E, Lass A. Prevalence of Asymptomatic Malaria Infections in Seemingly Healthy Children, the Rural Dzanga Sangha Region, Central African Republic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020814. [PMID: 33477889 PMCID: PMC7833374 DOI: 10.3390/ijerph18020814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 01/24/2023]
Abstract
According to the World Health Organization 94% of global malaria cases and 94% of global malaria deaths have been reported from Africa. Unfortunately, it is difficult to determine the exact prevalence of disease in some African countries due to a large number of asymptomatic cases. The aim of this study was to assess the prevalence of malaria infections in seemingly healthy children living in the Central African Republic (CAR). CareStartTM Malaria HRP2 rapid diagnostic test (RDT) targeting Plasmodium falciparum was used to test a group of 500 asymptomatic children aged 1-15 years old (330 settled Bantu and 170 semi-nomadic BaAka Pygmies) inhabiting the villages in the Dzanga Sangha region (south-west CAR) in March 2020. In total, 32.4% of asymptomatic Bantu and 40.6% of asymptomatic Pygmy children had a positive result of malaria RDT. Our findings allowed us to demonstrate the high prevalence of asymptomatic malaria infections in south-west CAR. RDTs seem to be a useful tool for the detection of Plasmodium falciparum in areas with limited possibilities of using other diagnostic methods, such as light microscopy and molecular biology.
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Affiliation(s)
- Krzysztof Korzeniewski
- Department of Epidemiology and Tropical Medicine, Military Institute of Medicine, 128 Szaserów St., 04-141 Warsaw, Poland
- Department of Occupational, Metabolic and Internal Diseases, Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, 9B Powstania Styczniowego St., 81-519 Gdynia, Poland
- Correspondence:
| | - Emilia Bylicka-Szczepanowska
- 4th Department of Infectious Diseases, Provincial Hospital for Infectious Diseases, 37 Wolska St., 01-201 Warsaw, Poland;
| | - Anna Lass
- Department of Tropical Parasitology, Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, 9B Powstania Styczniowego St., 81-519 Gdynia, Poland;
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Opoka RO, Conroy AL, Waiswa A, Wasswa R, Tumwine JK, Karamagi C, John CC. Severe Anemia Is Associated with Systemic Inflammation in Young Children Presenting to a Tertiary Hospital in Uganda. Am J Trop Med Hyg 2020; 103:2574-2580. [PMID: 32901609 PMCID: PMC7695059 DOI: 10.4269/ajtmh.20-0199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 07/29/2020] [Indexed: 11/07/2022] Open
Abstract
The role of inflammation in severe anemia (SA) in African children has not been well characterized. We conducted a study to evaluate risk factors for SA in young children admitted at a tertiary unit in Uganda. Clinical, infectious, and micronutrient risk factors for anemia, along with markers of inflammation, were evaluated in children aged < 5 years in Jinja Hospital, Uganda. Participants included 284 children with SA (Hemoglobin [Hb] < 5.0 g/dL), and two control groups: 63 children admitted with acute illness without SA (Hb > 9.3 g/dL) and 53 asymptomatic community control children. Appropriate logistic analysis was performed to determine factors associated with SA. Of the 284 children with SA, 36.5% had Plasmodium falciparum parasitemia, 32.7% had blackwater fever (one of the types of severe malaria), and 15.5% had vitamin B12 deficiency. HIV infection, bacteremia, hookworm infection, severe acute malnutrition, and folate deficiency were relatively uncommon (each accounting for < 8%). Factors independently associated with SA compared with the combined control groups included (adjusted odds ratio [OR]; 95% CI) the following: P. falciparum parasitemia (OR: 4.3; 95% CI: 1.4-13.8), total white blood count (OR: 1.3; 95% CI: 1.1-1.4), C-reactive protein (OR: 1.8; 95% CI: 1.3-2.4), and ferritin (OR: 2.7; 95% CI: 1.9-4.0). In this area of Uganda, malaria and markers of inflammation were independently associated with SA in children. Additional studies are required to determine the role of inflammation in children with SA in this population.
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Affiliation(s)
- Robert O. Opoka
- Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Andrea L. Conroy
- Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, Indiana
| | - Ali Waiswa
- Nalufenya Children’s Ward, Jinja Regional Referral Hospital, Jinja, Uganda
| | - Ronald Wasswa
- Global Health Uganda (GHU) Research Collaboration, Kampala, Uganda
| | - James K. Tumwine
- Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Charles Karamagi
- Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Chandy C. John
- Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, Indiana
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Ferreira LZ, Blumenberg C, Utazi CE, Nilsen K, Hartwig FP, Tatem AJ, Barros AJD. Geospatial estimation of reproductive, maternal, newborn and child health indicators: a systematic review of methodological aspects of studies based on household surveys. Int J Health Geogr 2020; 19:41. [PMID: 33050935 PMCID: PMC7552506 DOI: 10.1186/s12942-020-00239-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/05/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Geospatial approaches are increasingly used to produce fine spatial scale estimates of reproductive, maternal, newborn and child health (RMNCH) indicators in low- and middle-income countries (LMICs). This study aims to describe important methodological aspects and specificities of geospatial approaches applied to RMNCH coverage and impact outcomes and enable non-specialist readers to critically evaluate and interpret these studies. METHODS Two independent searches were carried out using Medline, Web of Science, Scopus, SCIELO and LILACS electronic databases. Studies based on survey data using geospatial approaches on RMNCH in LMICs were considered eligible. Studies whose outcomes were not measures of occurrence were excluded. RESULTS We identified 82 studies focused on over 30 different RMNCH outcomes. Bayesian hierarchical models were the predominant modeling approach found in 62 studies. 5 × 5 km estimates were the most common resolution and the main source of information was Demographic and Health Surveys. Model validation was under reported, with the out-of-sample method being reported in only 56% of the studies and 13% of the studies did not present a single validation metric. Uncertainty assessment and reporting lacked standardization, and more than a quarter of the studies failed to report any uncertainty measure. CONCLUSIONS The field of geospatial estimation focused on RMNCH outcomes is clearly expanding. However, despite the adoption of a standardized conceptual modeling framework for generating finer spatial scale estimates, methodological aspects such as model validation and uncertainty demand further attention as they are both essential in assisting the reader to evaluate the estimates that are being presented.
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Affiliation(s)
- Leonardo Z Ferreira
- International Center for Equity in Health, Universidade Federal de Pelotas, Pelotas, Brazil.
- Post-Graduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil.
| | - Cauane Blumenberg
- International Center for Equity in Health, Universidade Federal de Pelotas, Pelotas, Brazil
| | - C Edson Utazi
- WorldPop, Geography and Environmental Science, University of Southampton, Southampton, UK
| | - Kristine Nilsen
- WorldPop, Geography and Environmental Science, University of Southampton, Southampton, UK
| | - Fernando P Hartwig
- Post-Graduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Andrew J Tatem
- WorldPop, Geography and Environmental Science, University of Southampton, Southampton, UK
| | - Aluisio J D Barros
- International Center for Equity in Health, Universidade Federal de Pelotas, Pelotas, Brazil
- Post-Graduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
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11
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Siya A, Kalule BJ, Ssentongo B, Lukwa AT, Egeru A. Malaria patterns across altitudinal zones of Mount Elgon following intensified control and prevention programs in Uganda. BMC Infect Dis 2020; 20:425. [PMID: 32552870 PMCID: PMC7301530 DOI: 10.1186/s12879-020-05158-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 06/12/2020] [Indexed: 12/22/2022] Open
Abstract
Background Malaria remains a major tropical vector-borne disease of immense public health concern owing to its debilitating effects in sub-Saharan Africa. Over the past 30 years, the high altitude areas in Eastern Africa have been reported to experience increased cases of malaria. Governments including that of the Republic of Uganda have responded through intensifying programs that can potentially minimize malaria transmission while reducing associated fatalities. However, malaria patterns following these intensified control and prevention interventions in the changing climate remains widely unexplored in East African highland regions. This study thus analyzed malaria patterns across altitudinal zones of Mount Elgon, Uganda. Methods Times-series data on malaria cases (2011–2017) from five level III local health centers occurring across three altitudinal zones; low, mid and high altitude was utilized. Inverse Distance Weighted (IDW) interpolation regression and Mann Kendall trend test were used to analyze malaria patterns. Vegetation attributes from the three altitudinal zones were analyzed using Normalized Difference Vegetation Index (NDVI) was used to determine the Autoregressive Integrated Moving Average (ARIMA) model was used to project malaria patterns for a 7 year period. Results Malaria across the three zones declined over the study period. The hotspots for malaria were highly variable over time in all the three zones. Rainfall played a significant role in influencing malaria burdens across the three zones. Vegetation had a significant influence on malaria in the higher altitudes. Meanwhile, in the lower altitude, human population had a significant positive correlation with malaria cases. Conclusions Despite observed decline in malaria cases across the three altitudinal zones, the high altitude zone became a malaria hotspot as cases variably occurred in the zone. Rainfall played the biggest role in malaria trends. Human population appeared to influence malaria incidences in the low altitude areas partly due to population concentration in this zone. Malaria control interventions ought to be strengthened and strategically designed to achieve no malaria cases across all the altitudinal zones. Integration of climate information within malaria interventions can also strengthen eradication strategies of malaria in such differentiated altitudinal zones.
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Affiliation(s)
- Aggrey Siya
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P.O. Box 7062, Kampala, Uganda. .,Centre for Invasion Biology, Department of Botany and Zoology, Stellenbosch University, Stellenbosch, South Africa.
| | - Bosco John Kalule
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P.O. Box 7062, Kampala, Uganda
| | - Benard Ssentongo
- College of Agricultural and Environmental Sciences, Makerere University, P.O. Box 7062, Kampala, Uganda
| | - Akim Tafadzwa Lukwa
- Faculty of Health Sciences, School of Public Health and Family Medicine, Health Economics Unit, University of Cape Town, Cape Town, South Africa
| | - Anthony Egeru
- College of Agricultural and Environmental Sciences, Makerere University, P.O. Box 7062, Kampala, Uganda
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12
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Opoka RO, Waiswa A, Harriet N, John CC, Tumwine JK, Karamagi C. Blackwater Fever in Ugandan Children With Severe Anemia is Associated With Poor Postdischarge Outcomes: A Prospective Cohort Study. Clin Infect Dis 2020; 70:2247-2254. [PMID: 31300826 PMCID: PMC7245149 DOI: 10.1093/cid/ciz648] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 07/11/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Blackwater fever (BWF), one of the complications of severe malaria, has recently re-emerged as a cause of severe anemia (SA) in African children. However, postdischarge morbidity in children with BWF has previously not been described. METHODS This was a descriptive cohort study in which children, aged 0-5 years, admitted to Jinja Regional Referral Hospital with acute episodes of SA (hemoglobin ≤5.0 g/dL) were followed up for 6 months after hospitalization. Incidence of readmissions or deaths during the follow-up period was compared between SA children with BWF and those without BWF. RESULTS A total of 279 children with SA including those with BWF (n = 92) and no BWF (n = 187) were followed for the duration of the study. Overall, 128 (45.9%) of the study participants were readmitted at least once while 22 (7.9%) died during the follow-up period. After adjusting for age, sex, nutritional status, and parasitemia, SA children with BWF had higher risk of readmissions (hazard ratio [HR], 1.68; 95% confidence interval [CI], 1.1-2.5) and a greater risk of death (HR. 3.37; 95% CI, 1.3-8.5) compared with those without BWF. Malaria and recurrence of SA were the most common reasons for readmissions. CONCLUSIONS There is a high rate of readmissions and deaths in the immediate 6 months after initial hospitalization among SA children in the Jinja hospital. SA children with BWF had increased risk of readmissions and deaths in the postdischarge period. Postdischarge malaria chemoprophylaxis should be considered for SA children living in malaria endemic areas.
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Affiliation(s)
- Robert O Opoka
- Department of Pediatrics and Child Health, College of Health Sciences, Makerere University, Kampala
| | - Ali Waiswa
- Global Health Uganda (GHU) Research Collaboration, Kampala
| | - Nambuya Harriet
- Nalufenya Children’s Ward, Jinja Regional Referral Hospital, Uganda
| | - Chandy C John
- Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis
| | - James K Tumwine
- Department of Pediatrics and Child Health, College of Health Sciences, Makerere University, Kampala
| | - Charles Karamagi
- Department of Pediatrics and Child Health, College of Health Sciences, Makerere University, Kampala
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13
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Nawa M, Halwindi H, Hangoma P. Modelling malaria reduction in a highly endemic country: Evidence from household survey, climate, and program data in Zambia. J Public Health Afr 2020; 11:1096. [PMID: 33209231 PMCID: PMC7649733 DOI: 10.4081/jphia.2020.1096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 10/17/2019] [Indexed: 12/03/2022] Open
Abstract
Substantial efforts have seen the reduction in malaria prevalence from 33% in 2006 to 19.4% in 2015 in Zambia. Many studies have used effect measures, such as odds ratios, of malaria interventions without combining this information with coverage levels of the interventions to assess how malaria prevalence would change if these interventions were scaled up. We contribute to filling this gap by combining intervention coverage information with marginal predictions to model the extent to which key interventions can bring down malaria in Zambia. We used logistic regression models and derived marginal effects using repeated cross-sectional survey data from the Malaria Indicator Survey (MIS) datasets for Zambia collected in 2010, 2012 and 2015. Average monthly temperature and rainfall data were obtained from climate explorer a satellite-generated database. We then conducted a counterfactual analysis using the estimated marginal effects and various hypothetical levels of intervention coverage to assess how different levels of coverage would affect malaria prevalence. Increasing IRS and ITNs from the 2015 levels of coverage of 28.9% and 58.9% respectively to at least 80% and rising standard housing to 20% from the 13.4% in 2015 may bring malaria prevalence down to below 15%. If the percentage of modern houses were increased further to 90%, malaria prevalence might decrease to 10%. Other than ITN and IRS, streamlining and increasing of the percentage of standard houses in malaria fight would augment and bring malaria down to the levels needed for focal malaria elimination. The effects of ITNs, IRS and Standard housing were pronounced in high than low epidemiological areas.
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Affiliation(s)
| | - Hikabasa Halwindi
- Department of Community and Family Medicine, University of Zambia, School of Public Health, Lusaka, Zambia
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14
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Manda S, Haushona N, Bergquist R. A Scoping Review of Spatial Analysis Approaches Using Health Survey Data in Sub-Saharan Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3070. [PMID: 32354095 PMCID: PMC7246597 DOI: 10.3390/ijerph17093070] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/01/2020] [Accepted: 04/03/2020] [Indexed: 01/03/2023]
Abstract
Spatial analysis has become an increasingly used analytic approach to describe and analyze spatial characteristics of disease burden, but the depth and coverage of its usage for health surveys data in Sub-Saharan Africa are not well known. The objective of this scoping review was to conduct an evaluation of studies using spatial statistics approaches for national health survey data in the SSA region. An organized literature search for studies related to spatial statistics and national health surveys was conducted through PMC, PubMed/Medline, Scopus, NLM Catalog, and Science Direct electronic databases. Of the 4,193 unique articles identified, 153 were included in the final review. Spatial smoothing and prediction methods were predominant (n = 108), followed by spatial description aggregation (n = 25), and spatial autocorrelation and clustering (n = 19). Bayesian statistics methods and lattice data modelling were predominant (n = 108). Most studies focused on malaria and fever (n = 47) followed by health services coverage (n = 38). Only fifteen studies employed nonstandard spatial analyses (e.g., spatial model assessment, joint spatial modelling, accounting for survey design). We recommend that for future spatial analysis using health survey data in the SSA region, there must be an improve recognition and awareness of the potential dangers of a naïve application of spatial statistical methods. We also recommend a wide range of applications using big health data and the future of data science for health systems to monitor and evaluate impacts that are not well understood at local levels.
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Affiliation(s)
- Samuel Manda
- Biostatistics Research Unit, South African Medical Research Council, Pretoria 0001, South Africa
- Department of Statistics, University of Pretoria, Pretoria 0002, South Africa
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Pietermaritzburg 3209, South Africa
| | - Ndamonaonghenda Haushona
- Biostatistics Research Unit, South African Medical Research Council, Pretoria 0001, South Africa
- Division of Epidemiology and Biostatistics, University of Stellenbosch, Cape Town 8000, South Africa
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15
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Dietler D, Leuenberger A, Bempong NE, Campbell-Lendrum D, Cramer C, Eggen RIL, Erismann S, Ferazzi S, Flahault A, Fletcher HA, Fuhrer B, Fuhrimann S, Greter H, Heerdegen AC, Leach M, Leissing A, Lilje J, Penny MA, Prytherch H, Staudacher P, Vounatsou P, Weiss F, Wiedemann R, Winkler MS, Zhou XN, Utzinger J. Health in the 2030 Agenda for Sustainable Development: from framework to action, transforming challenges into opportunities. J Glob Health 2020; 9:020201. [PMID: 31489184 PMCID: PMC6708592 DOI: 10.7189/jogh.09.020201] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Dominik Dietler
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland.,Equal contributions
| | - Andrea Leuenberger
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland.,Equal contributions
| | - Nefti-Eboni Bempong
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Diarmid Campbell-Lendrum
- Department of Public Health, Environmental and Social Determinants of Health, World Health Organization, Geneva, Switzerland
| | - Conradin Cramer
- University of Basel, Basel, Switzerland.,Department of Education, Basel, Switzerland
| | - Rik I L Eggen
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Dübendorf, Switzerland.,ETH Zurich, Federal Institute of Technology, Zurich, Switzerland
| | - Séverine Erismann
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | | | - Antoine Flahault
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | | | - Bernhard Fuhrer
- Swiss Network for International Studies, Geneva, Switzerland
| | - Samuel Fuhrimann
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Helena Greter
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Anne Christine Heerdegen
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Melissa Leach
- Institute of Development Studies, University of Sussex, Brighton, United Kingdom
| | | | - Jonathan Lilje
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Dübendorf, Switzerland.,ETH Zurich, Federal Institute of Technology, Zurich, Switzerland
| | - Melissa A Penny
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Helen Prytherch
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Philipp Staudacher
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Dübendorf, Switzerland.,ETH Zurich, Federal Institute of Technology, Zurich, Switzerland
| | - Penelope Vounatsou
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Frederik Weiss
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Dübendorf, Switzerland.,ETH Zurich, Federal Institute of Technology, Zurich, Switzerland
| | - Ruth Wiedemann
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Dübendorf, Switzerland.,Institute of Political Science, University of Bern, Bern, Switzerland
| | - Mirko S Winkler
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Xiao-Nong Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, People's Republic of China.,Key Laboratory of Parasite and Vector Biology, Ministry of Health, Shanghai, People's Republic of China
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
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16
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Effect of Free Healthcare Policy for Children under Five Years Old on the Incidence of Reported Malaria Cases in Burkina Faso by Bayesian Modelling: "Not only the Ears but also the Head of the Hippopotamus". INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17020417. [PMID: 31936308 PMCID: PMC7014427 DOI: 10.3390/ijerph17020417] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 12/24/2019] [Accepted: 01/03/2020] [Indexed: 02/02/2023]
Abstract
Burkina Faso has recently implemented an additional strategy, the free healthcare policy, to further improve maternal and child health. This policy targets children under five who bear the brunt of the malaria scourge. The effects of the free-of-charge healthcare were previously assessed in women but not in children. The present study aims at filling this gap by assessing the effect of this policy in children under five with a focus on the induced spatial and temporal changes in malaria morbidity. We used a Bayesian spatiotemporal negative binomial model to investigate the space–time variation in malaria incidence in relation to the implementation of the policy. The analysis relied on malaria routine surveillance data extracted from the national health data repository and spanning the period from January 2013 to December 2018. The model was adjusted for meteorological and contextual confounders. We found that the number of presumed and confirmed malaria cases per 1000 children per month increased between 2013 and 2018. We further found that the implementation of the free healthcare policy was significantly associated with a two-fold increase in the number of tested and confirmed malaria cases compared with the period before the policy rollout. This effect was, however, heterogeneous across the health districts. We attributed the rise in malaria incidence following the policy rollout to an increased use of health services combined with an increased availability of rapid tests and a higher compliance to the “test and treat” policy. The observed heterogeneity in the policy effect was attributed to parallel control interventions, some of which were rolled out at different paces and scales. Our findings call for a sustained and reinforced effort to test all suspected cases so that, alongside an improved case treatment, the true picture of the malaria scourge in children under five emerges clearly (see the hippopotamus almost entirely).
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Risk Factors for Infectious Diseases in Urban Environments of Sub-Saharan Africa: A Systematic Review and Critical Appraisal of Evidence. Trop Med Infect Dis 2019; 4:tropicalmed4040123. [PMID: 31569517 PMCID: PMC6958454 DOI: 10.3390/tropicalmed4040123] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/04/2019] [Accepted: 09/20/2019] [Indexed: 12/19/2022] Open
Abstract
Our world is rapidly urbanizing. According to the United Nations, between 1990 and 2015, the percent of the world’s population living in urban areas grew from 43% to 54%. Estimates suggest that this trend will continue and that over 68% of the world’s population will call cities home by 2050, with the majority of urbanization occurring in African countries. This urbanization is already having a profound effect on global health and could significantly impact the epidemiology of infectious diseases. A better understanding of infectious disease risk factors specific to urban settings is needed to plan for and mitigate against future urban outbreaks. We conducted a systematic literature review of the Web of Science and PubMed databases to assess the risk factors for infectious diseases in the urban environments of sub-Saharan Africa. A search combining keywords associated with cities, migration, African countries, infectious disease, and risk were used to identify relevant studies. Original research and meta-analyses published between 2004 and 2019 investigating geographical and behavioral risk factors, changing disease distributions, or control programs were included in the study. The search yielded 3610 papers, and 106 met the criteria for inclusion in the analysis. Papers were categorized according to risk factors, geographic area, and study type. The papers covered 31 countries in sub-Saharan Africa with East Africa being the most represented sub-region. Malaria and HIV were the most frequent disease focuses of the studies. The results of this work can inform public health policy as it relates to capacity building and health systems strengthening in rapidly urbanizing areas, as well as highlight knowledge gaps that warrant additional research.
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Okethwangu D, Opigo J, Atugonza S, Kizza CT, Nabatanzi M, Biribawa C, Kyabayinze D, Ario AR. Factors associated with uptake of optimal doses of intermittent preventive treatment for malaria among pregnant women in Uganda: analysis of data from the Uganda Demographic and Health Survey, 2016. Malar J 2019; 18:250. [PMID: 31349829 PMCID: PMC6660695 DOI: 10.1186/s12936-019-2883-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 07/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Uganda National Malaria Control Programme recognizes the importance of minimizing the effect of malaria among pregnant women. Accordingly, strategies including intermittent preventive treatment of malaria in pregnancy using sulfadoxine-pyrimethamine (IPTp-SP) have been scaled up. Uptake of IPTp-SP among pregnant women in Uganda, aged 15-49 years who had had a live birth 2 years preceding the 2016 Uganda Demographic and Health Survey (UDHS) was determined and factors associated with the uptake of optimal IPTp-SP doses were identified. METHODS This was a secondary analysis of the UDHS 2016 dataset. The outcome variable was uptake of IPTp-SP doses among women 15-49 years old who had had a live birth 2 years preceding the survey. Independent variables were residence type, age, marital status, education, wealth status, region of residence, parity, number of antenatal care (ANC) attendance, timing to first ANC visit, and exposure to messages through radio. Logistic regression was used to identify factors associated with the uptake of optimal IPTp-SP doses. RESULTS Uptake of three or more doses of IPTp-SP was 18%. The likelihood of taking optimal doses of IPTp-SP was increased among those who had attained a secondary-level education (aOR: 1.5, 95% CI 1.04-2.15), those who attended ANC ≥ 4 times (aOR: 1.34, 95% CI 1.12-1.60), and those exposed to radio messages (aOR: 1.23, 95% CI 1.02-1.48). Among those in the age category > 34 years (aOR: 0.70, 95% CI 0.53-0.92), and those who attended first ANC in the third trimester of pregnancy (aOR: 0.58, 95% CI 0.38-0.87) the odds of uptake were decreased. CONCLUSIONS Education status, exposure to radio messages about health and frequency of ANC attendance were associated with increased uptake while timing of first ANC attendance and being > 34 years were associated with decreased uptake. The findings suggest a need to strengthen behaviour change communication among women of child-bearing age in order to improve uptake of IPTp-SP during pregnancy.
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Affiliation(s)
- Denis Okethwangu
- Uganda Public Health Fellowship Programme, Kampala, Uganda. .,Uganda National Malaria Control Programme, Ministry of Health, Kampala, Uganda.
| | - Jimmy Opigo
- Uganda National Malaria Control Programme, Ministry of Health, Kampala, Uganda
| | | | - Catherine T Kizza
- Makerere University College of Health Sciences, School of Medicine, Kampala, Uganda
| | - Monica Nabatanzi
- Uganda National Malaria Control Programme, Ministry of Health, Kampala, Uganda
| | | | - Daniel Kyabayinze
- Uganda National Malaria Control Programme, Ministry of Health, Kampala, Uganda
| | - Alex R Ario
- Uganda Public Health Fellowship Programme, Kampala, Uganda
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The effects and contribution of childhood diseases on the geographical distribution of all-cause under-five mortality in Uganda. Parasite Epidemiol Control 2019; 5:e00089. [PMID: 30923753 PMCID: PMC6424012 DOI: 10.1016/j.parepi.2019.e00089] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 01/29/2019] [Accepted: 01/30/2019] [Indexed: 12/18/2022] Open
Abstract
Introduction Information on the causes of death among under-five children is key in designing and implementation of appropriate interventions. In Uganda, civil death registration is incomplete which limits the estimation of disease-related mortality burden especially at a local scale. In the absence of routine cause-specific data, we used household surveys to quantify the effects and contribution of main childhood diseases such as malaria, severe or moderate anaemia, severe or moderate malnutrition, diarrhoea and acute respiratory infections (ARIs) on all-cause under-five mortality (U5M) at national and sub-national levels. We related all-cause U5M with risks of childhood diseases after adjusting for geographical disparities in coverages of health interventions, socio-economic, environmental factors and disease co-endemicities. Methods Data on U5M, disease prevalence, socio-economic and intervention coverage indicators were obtained from the 2011 Demographic and Health Survey, while data on malaria prevalence were extracted from the 2009 Malaria Indicator Survey. Bayesian geostatistical Weibull proportional hazards models with spatially varying disease effects at sub-national scales were fitted to quantify the associations between childhood diseases and the U5M. Spatial correlation between clusters was incorporated via locational random effects while region-specific random effects with conditional autoregressive prior distributions modeled the geographical variation in the effects of childhood diseases. The models addressed geographical misalignment in the locations of the two surveys. The contribution of childhood diseases to under-five mortality was estimated using population attributable fractions. Results The overall U5M rate was 90 deaths per 1000 live births. Large regional variations in U5M rates were observed, lowest in Kampala at 56 and highest in the North-East at 152 per 1000 live births. National malaria parasitemia prevalence was 42%, with Kampala experiencing the lowest of 5% and the Mid-North the highest of 62%. About 27% of Ugandan children aged 6–59 months were severely or moderately anaemic; lowest in South-West (8%) and highest in East-Central (46%). Overall, 17% of children were either severely or moderately malnourished. The percentage of moderately/severely malnourished children varied by region with Kampala having the lowest (8%) and North-East the highest (45%). Nearly a quarter of the children under-five years were reported to have diarrhoea at national level, and this proportion was highest in East-Central (32%) and Mid-Eastern (33%) and lowest in South-West (14%). Overall, ARIs in the two weeks before the survey was 15%; highest in Mid-North (22%) and lowest in Central 1 (9%). At national level, the U5M was associated with prevalence of malaria (hazard ratio (HR) = 1.74; 95% BCI: 1.42, 2.16), severe or moderate anaemia (HR =1.37; 95% BCI: 1.20, 1.75), severe or moderate malnutrition (HR = 1.49; 95% BCI: 1.25, 1.66) and diarrhoea (HR = 1.61; 95% BCI: 1.31, 2.05). The relationship between malaria and U5M was important in the regions of Central 2, East-Central, Mid-North, North-East and West-Nile. Diarrhoea was associated with under-five deaths in Central 2, East-central, Mid-Eastern and Mid-Western. Moderate/severe malnutrition was associated with U5M in East-Central, Mid-Eastern and North-East. Moderate/severe anaemia was associated with deaths in Central 1, Kampala, Mid-North, Mid-Western, North-East, South-West and West-Nile. At the national level, 97% (PAF = 96.9; 95%BCI: 94.4, 98.0), 91% (PAF = 90.9; 95%BCI: 84.4, 95.3), 89% (PAF = 89.3; 95%BCI: 76.0,93.8) and 93% (PAF = 93.3 95%BCI: 87.7,96.0) of the deaths among children less than five years in Uganda were attributable to malaria, severe/moderate anaemia, severe/moderate malnutrition and diarrhoea respectively. The attribution of malaria was comparable in Central 2, East-Central, Mid-North, North-East and West-Nile while severe/moderate anaemia was more common in all regions except Central 2, East-Central and Mid-Eastern. The attribution of diarrhoea in Central 2, East-Central, Mid-Eastern and Mid-Western was similar. The attribution of severe/moderate malnutrition was common in East-Central, Mid-Eastern and North-East. Conclusion In Uganda, the contribution and effects of childhood diseases on U5M vary by region. Majority of the under-five deaths are due to malaria, followed by diarrhoea, severe/moderate anaemia and severe/moderate malnutrition. Thus, strengthening disease-specific interventions especially in the affected regions may be an important strategy to accelerate progress towards the reduction of the U5M as per the SDG target by 2030. In particular, Indoor Residual Spraying, iron supplementation, deworming, exclusive breastfeeding, investment in nutrition and education in nutrition practices, oral rehydration therapy or recommended home fluid, improved sanitation facilities should be improved.
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Measuring health facility readiness and its effects on severe malaria outcomes in Uganda. Sci Rep 2018; 8:17928. [PMID: 30560884 PMCID: PMC6298957 DOI: 10.1038/s41598-018-36249-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 11/06/2018] [Indexed: 12/14/2022] Open
Abstract
There is paucity of evidence for the role of health service delivery to the malaria decline in Uganda We developed a methodology to quantify health facility readiness and assessed its role on severe malaria outcomes among lower-level facilities (HCIIIs and HCIIs) in the country. Malaria data was extracted from the Health Management Information System (HMIS). General service and malaria-specific readiness indicators were obtained from the 2013 Uganda service delivery indicator survey. Multiple correspondence analysis (MCA) was used to construct a composite facility readiness score based on multiple factorial axes. Geostatistical models assessed the effect of facility readiness on malaria deaths and severe cases. Malaria readiness was achieved in one-quarter of the facilities. The composite readiness score explained 48% and 46% of the variation in the original indicators compared to 23% and 27%, explained by the first axis alone for HCIIIs and HCIIs, respectively. Mortality rate was 64% (IRR = 0.36, 95% BCI: 0.14–0.61) and 68% (IRR = 0.32, 95% BCI: 0.12–0.54) lower in the medium and high compared to low readiness groups, respectively. A composite readiness index is more informative and consistent than the one based on the first MCA factorial axis. In Uganda, higher facility readiness is associated with a reduced risk of severe malaria outcomes.
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Maziarz M, Nabalende H, Otim I, Legason ID, Kinyera T, Ogwang MD, Talisuna AO, Reynolds SJ, Kerchan P, Bhatia K, Biggar RJ, Goedert JJ, Pfeiffer RM, Mbulaiteye SM. A cross-sectional study of asymptomatic Plasmodium falciparum infection burden and risk factors in general population children in 12 villages in northern Uganda. Malar J 2018; 17:240. [PMID: 29925378 PMCID: PMC6011516 DOI: 10.1186/s12936-018-2379-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 06/08/2018] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Plasmodium falciparum malaria is an important cause of morbidity in northern Uganda. This study was undertaken to assess village-, household-, and individual-level risk factors of asymptomatic falciparum malaria in children in 12 villages in northern Uganda. METHODS Between 10/2011 and 02/2014, 1006 apparently healthy children under 16 years old were enrolled in 12 villages using a stratified, multi-stage, cluster survey design and assessed for P. falciparum malaria infection using the rapid diagnostic test (RDT) and thick film microscopy (TFM), and structured interviewer-administered questionnaires. Associations between weighted P. falciparum malaria prevalence (pfPR), based on RDT, and covariates were estimated as odds ratios and 95% confidence intervals (ORs, 95% CIs) using logistic models accounting for the survey design. RESULTS Among 942 (93.5%) children successfully tested, pfPR was 52.4% by RDT and 32.7% by TFM. Overall pfPR was lower in villages where indoor residual insecticide spray (IRS) was, versus not, implemented (18.4% versus 75.2%, P < 0.0001). However, pfPR was heterogeneous both within IRS (10.6-34.8%) and non-IRS villages (63.6-86.2%). Elevated pfPR was associated with having a sibling who was RDT positive (OR 5.39, 95% CI 2.94-9.90, P = 0.0006) and reporting a fever at enrollment (aOR 4.80, 95% CI 1.94-11.9, P = 0.0094). Decreased pfPR was associated with living in an IRS village (adjusted OR 0.06, 95% CI 0.04-0.07, P < 0.0001), in a household with one (aOR 0.48, 95% CI 0.30-0.76) or more than one child below 5 years (aOR 0.23, 95% CI 0.12-0.44, Ptrend = 0.014), and reporting keeping a goat inside or near the house (aOR 0.42, 95% CI 0.29-0.62, P = 0.0021). CONCLUSIONS The results show high but heterogeneous pfPR in villages in northern Uganda, confirm significantly decreased pfPR associated with IRS implementation, and suggest significant associations with some household characteristics. Further research is needed to elucidate the factors influencing malaria heterogeneity in villages in Uganda.
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Affiliation(s)
- Marlena Maziarz
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr, Rm. 6E118 MSC 9706, Bethesda, MD, 20892-9704, USA
| | - Hadijah Nabalende
- EMBLEM Study, African Field Epidemiology Network, Kampala & St. Mary's Hospital, Lacor, Gulu, Uganda
| | - Isaac Otim
- EMBLEM Study, African Field Epidemiology Network, Kampala & St. Mary's Hospital, Lacor, Gulu, Uganda
| | - Ismail D Legason
- EMBLEM Study, African Field Epidemiology Network, Kampala & St. Mary's Hospital, Lacor, Gulu, Uganda
| | - Tobias Kinyera
- EMBLEM Study, African Field Epidemiology Network, Kampala & St. Mary's Hospital, Lacor, Gulu, Uganda
| | - Martin D Ogwang
- EMBLEM Study, African Field Epidemiology Network, Kampala & St. Mary's Hospital, Lacor, Gulu, Uganda
| | - Ambrose O Talisuna
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Steven J Reynolds
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Patrick Kerchan
- EMBLEM Study, African Field Epidemiology Network, Kampala & St. Mary's Hospital, Lacor, Gulu, Uganda
| | - Kishor Bhatia
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr, Rm. 6E118 MSC 9706, Bethesda, MD, 20892-9704, USA
| | - Robert J Biggar
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr, Rm. 6E118 MSC 9706, Bethesda, MD, 20892-9704, USA
| | - James J Goedert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr, Rm. 6E118 MSC 9706, Bethesda, MD, 20892-9704, USA
| | - Ruth M Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr, Rm. 6E118 MSC 9706, Bethesda, MD, 20892-9704, USA
| | - Sam M Mbulaiteye
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr, Rm. 6E118 MSC 9706, Bethesda, MD, 20892-9704, USA.
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Ssempiira J, Kissa J, Nambuusi B, Mukooyo E, Opigo J, Makumbi F, Kasasa S, Vounatsou P. Interactions between climatic changes and intervention effects on malaria spatio-temporal dynamics in Uganda. Parasite Epidemiol Control 2018; 3:e00070. [PMID: 29988311 PMCID: PMC6020080 DOI: 10.1016/j.parepi.2018.e00070] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/16/2018] [Accepted: 04/22/2018] [Indexed: 11/14/2022] Open
Abstract
Background Although malaria burden in Uganda has declined since 2009 following the scale-up of interventions, the disease is still the leading cause of hospitalization and death. Transmission remains high and is driven by suitable weather conditions. There is a real concern that intervention gains may be reversed by climatic changes in the country. In this study, we investigate the effects of climate on the spatio-temporal trends of malaria incidence in Uganda during 2013–2017. Methods Bayesian spatio-temporal negative binomial models were fitted on district-aggregated monthly malaria cases, reported by two age groups, defined by a cut-off age of 5 years. Weather data was obtained from remote sensing sources including rainfall, day land surface temperature (LSTD) and night land surface temperature (LSTN), Normalized Difference Vegetation Index (NDVI), altitude, land cover, and distance to water bodies. Spatial and temporal correlations were taken into account by assuming a conditional autoregressive and a first-order autoregressive process on district and monthly specific random effects, respectively. Fourier trigonometric functions modeled seasonal fluctuations in malaria transmission. The effects of climatic changes on the malaria incidence changes between 2013 and 2017 were estimated by modeling the difference in time varying climatic conditions at the two time points and adjusting for the effects of intervention coverage, socio-economic status and health seeking behavior. Results Malaria incidence declined steadily from 2013 to 2015 and then increased in 2016. The decrease was by over 38% and 20% in children <5 years and individuals ≥5 years, respectively. Temporal trends depict a strong bi-annual seasonal pattern with two peaks during April–June and October–December. The annual average of rainfall, LSTD and LSTN increased by 3.7 mm, 2.2 °C and 1.0 °C, respectively, between 2013 and 2017, whereas NDVI decreased by 6.8%. On the one hand, the increase in LSTD and decrease in NDVI were associated with a reduction in the incidence decline. On the other hand, malaria interventions and treatment seeking behavior had reverse effects, that were stronger compared to the effects of climatic changes. Important interactions between interventions with NDVI and LSTD suggest a varying impact of interventions on malaria burden in different climatic conditions. Conclusion Climatic changes in Uganda during the last five years contributed to a favorable environment for malaria transmission, and had a detrimental effect on malaria reduction gains achieved through interventions scale-up efforts. The NMCP should create synergies with the National Meteorological Authority with an ultimate goal of developing a Malaria Early Warning System to mitigate adverse climatic change effects on malaria risk in the country.
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Affiliation(s)
- Julius Ssempiira
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051 Basel, Switzerland.,University of Basel, Petersplatz 1, 4001 Basel, Switzerland.,Makerere University School of Public Health, New Mulago Hospital Complex, P.O Box 7072, Kampala, Uganda
| | - John Kissa
- Ministry of Health, Plot 6 Lourdel Road, Nakasero, P.O. Box 7272, Kampala, Uganda
| | - Betty Nambuusi
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051 Basel, Switzerland.,University of Basel, Petersplatz 1, 4001 Basel, Switzerland.,Makerere University School of Public Health, New Mulago Hospital Complex, P.O Box 7072, Kampala, Uganda
| | - Eddie Mukooyo
- Ministry of Health, Plot 6 Lourdel Road, Nakasero, P.O. Box 7272, Kampala, Uganda
| | - Jimmy Opigo
- Ministry of Health, Plot 6 Lourdel Road, Nakasero, P.O. Box 7272, Kampala, Uganda
| | - Fredrick Makumbi
- Makerere University School of Public Health, New Mulago Hospital Complex, P.O Box 7072, Kampala, Uganda
| | - Simon Kasasa
- Makerere University School of Public Health, New Mulago Hospital Complex, P.O Box 7072, Kampala, Uganda
| | - Penelope Vounatsou
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051 Basel, Switzerland.,University of Basel, Petersplatz 1, 4001 Basel, Switzerland
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Ssempiira J, Kissa J, Nambuusi B, Kyozira C, Rutazaana D, Mukooyo E, Opigo J, Makumbi F, Kasasa S, Vounatsou P. The effect of case management and vector-control interventions on space-time patterns of malaria incidence in Uganda. Malar J 2018; 17:162. [PMID: 29650005 PMCID: PMC5898071 DOI: 10.1186/s12936-018-2312-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 04/06/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Electronic reporting of routine health facility data in Uganda began with the adoption of the District Health Information Software System version 2 (DHIS2) in 2011. This has improved health facility reporting and overall data quality. In this study, the effects of case management with artemisinin-based combination therapy (ACT) and vector control interventions on space-time patterns of disease incidence were determined using DHIS2 data reported during 2013-2016. METHODS Bayesian spatio-temporal negative binomial models were fitted on district-aggregated monthly malaria cases, reported by two age groups, defined by a cut-off age of 5 years. The effects of interventions were adjusted for socio-economic and climatic factors. Spatial and temporal correlations were taken into account by assuming a conditional autoregressive and a first-order autoregressive AR(1) process on district and monthly specific random effects, respectively. Fourier trigonometric functions were incorporated in the models to take into account seasonal fluctuations in malaria transmission. RESULTS The temporal variation in incidence was similar in both age groups and depicted a steady decline up to February 2014, followed by an increase from March 2015 onwards. The trends were characterized by a strong bi-annual seasonal pattern with two peaks during May-July and September-December. Average monthly incidence in children < 5 years declined from 74.7 cases (95% CI 72.4-77.1) in 2013 to 49.4 (95% CI 42.9-55.8) per 1000 in 2015 and followed by an increase in 2016 of up to 51.3 (95% CI 42.9-55.8). In individuals ≥ 5 years, a decline in incidence from 2013 to 2015 was followed by an increase in 2016. A 100% increase in insecticide-treated nets (ITN) coverage was associated with a decline in incidence by 44% (95% BCI 28-59%). Similarly, a 100% increase in ACT coverage reduces incidence by 28% (95% BCI 11-45%) and 25% (95% BCI 20-28%) in children < 5 years and individuals ≥ 5 years, respectively. The ITN effect was not statistically important in older individuals. The space-time patterns of malaria incidence in children < 5 are similar to those of parasitaemia risk predicted from the malaria indicator survey of 2014-15. CONCLUSION The decline in malaria incidence highlights the effectiveness of vector-control interventions and case management with ACT in Uganda. This calls for optimizing and sustaining interventions to achieve universal coverage and curb reverses in malaria decline.
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Affiliation(s)
- Julius Ssempiira
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051, Basel, Switzerland.,University of Basel, Petersplatz 1, 4001, Basel, Switzerland.,Makerere University School of Public Health, New Mulago Hospital Complex, P.O Box 7072, Kampala, Uganda
| | - John Kissa
- Uganda Ministry of Health, Plot 6 Lourdel Road, P.O. Box 7272, Nakasero, Kampala, Uganda
| | - Betty Nambuusi
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051, Basel, Switzerland.,University of Basel, Petersplatz 1, 4001, Basel, Switzerland.,Makerere University School of Public Health, New Mulago Hospital Complex, P.O Box 7072, Kampala, Uganda
| | - Carol Kyozira
- Uganda Ministry of Health, Plot 6 Lourdel Road, P.O. Box 7272, Nakasero, Kampala, Uganda
| | - Damian Rutazaana
- Uganda Ministry of Health, Plot 6 Lourdel Road, P.O. Box 7272, Nakasero, Kampala, Uganda
| | - Eddie Mukooyo
- Uganda Ministry of Health, Plot 6 Lourdel Road, P.O. Box 7272, Nakasero, Kampala, Uganda
| | - Jimmy Opigo
- Uganda Ministry of Health, Plot 6 Lourdel Road, P.O. Box 7272, Nakasero, Kampala, Uganda
| | - Fredrick Makumbi
- Makerere University School of Public Health, New Mulago Hospital Complex, P.O Box 7072, Kampala, Uganda
| | - Simon Kasasa
- Makerere University School of Public Health, New Mulago Hospital Complex, P.O Box 7072, Kampala, Uganda
| | - Penelope Vounatsou
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051, Basel, Switzerland. .,University of Basel, Petersplatz 1, 4001, Basel, Switzerland.
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