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Abstract
A portion of the economics literature has long debated about the relative importance of historical, institutional, geographical, and health determinants of economic growth. In 2001, Gallup and Sachs quantified the association between malaria and the level and growth of per capita income over the period 1965–1995 in a cross-country regression framework. We took a contemporary look at Gallup and Sachs’ seminal work in the context of significant progress in malaria control achieved globally since 2000. Focusing on the period 2000–2017, we used the latest data available on malaria case incidence and other determinants of economic growth, as well as macro-econometric methods that are now the professional norm. In our preferred specification using a fixed-effects model, a 10% decrease in malaria incidence was associated with an increase in income per capita of nearly 0.3% on average and a 0.11 percentage point faster per capita growth per annum. Greater average income gains were expected among higher burden countries and those with lower income. Growth of industries with the same level of labor intensity was found to be significantly slower in countries with higher malaria incidence. To analyze the causal impact of malaria on economic outcomes, we used malaria treatment failure and pyrethroid-only insecticide resistance as exogeneous instruments in two-stage least squares estimations. Despite several methodological challenges, as expected in these types of analyses, our findings confirm the intrinsic link between malaria and economic growth and underscore the importance of malaria control in the agenda for sustainable development.
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Affiliation(s)
- Nayantara Sarma
- Department of International Economics, The Graduate Institute, Geneva, Switzerland
| | | | | | - Jean-Louis Arcand
- Department of International Economics, The Graduate Institute, Geneva, Switzerland
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2
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Abstract
BACKGROUND A core set of intervention and treatment options are recommended by the World Health Organization for use against falciparum malaria. These are treatment, long-lasting insecticide-treated bed nets, indoor residual spraying, and chemoprevention options. Both domestic and foreign aid funding for these tools is limited. When faced with budget restrictions, the introduction and scale-up of intervention and treatment options must be prioritized. METHODS Estimates of the cost and impact of different interventions were combined with a mathematical model of malaria transmission to estimate the most cost-effective prioritization of interventions. The incremental cost effectiveness ratio was used to select between scaling coverage of current interventions or the introduction of an additional intervention tool. RESULTS Prevention, in the form of vector control, is highly cost effective and scale-up is prioritized in all scenarios. Prevention reduces malaria burden and therefore allows treatment to be implemented in a more cost-effective manner by reducing the strain on the health system. The chemoprevention measures (seasonal malaria chemoprevention and intermittent preventive treatment in infants) are additional tools that, provided sufficient funding, are implemented alongside treatment scale-up. Future tools, such as RTS,S vaccine, have impact in areas of higher transmission but were introduced later than core interventions. CONCLUSIONS In a programme that is budget restricted, it is essential that investment in available tools be effectively prioritized to maximize impact for a given investment. The cornerstones of malaria control: vector control and treatment, remain vital, but questions of when to scale and when to introduce other interventions must be rigorously assessed. This quantitative analysis considers the scale-up or core interventions to inform decision making in this area.
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Affiliation(s)
- Peter Winskill
- MRC Centre of Global Infectious Disease Analysis, School of Public Health, Faculty of Medicine, Imperial College London, St Mary's Campus, London, W2 1PG, UK.
| | - Patrick G Walker
- MRC Centre of Global Infectious Disease Analysis, School of Public Health, Faculty of Medicine, Imperial College London, St Mary's Campus, London, W2 1PG, UK
| | | | - Azra C Ghani
- MRC Centre of Global Infectious Disease Analysis, School of Public Health, Faculty of Medicine, Imperial College London, St Mary's Campus, London, W2 1PG, UK
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3
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Yé Y, Eisele TP, Eckert E, Korenromp E, Shah JA, Hershey CL, Ivanovich E, Newby H, Carvajal-Velez L, Lynch M, Komatsu R, Cibulskis RE, Moore Z, Bhattarai A. Framework for Evaluating the Health Impact of the Scale-Up of Malaria Control Interventions on All-Cause Child Mortality in Sub-Saharan Africa. Am J Trop Med Hyg 2017; 97:9-19. [PMID: 28990923 PMCID: PMC5619929 DOI: 10.4269/ajtmh.15-0363] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Concerted efforts from national and international partners have scaled up malaria control interventions, including insecticide-treated nets, indoor residual spraying, diagnostics, prompt and effective treatment of malaria cases, and intermittent preventive treatment during pregnancy in sub-Saharan Africa (SSA). This scale-up warrants an assessment of its health impact to guide future efforts and investments; however, measuring malaria-specific mortality and the overall impact of malaria control interventions remains challenging. In 2007, Roll Back Malaria's Monitoring and Evaluation Reference Group proposed a theoretical framework for evaluating the impact of full-coverage malaria control interventions on morbidity and mortality in high-burden SSA countries. Recently, several evaluations have contributed new ideas and lessons to strengthen this plausibility design. This paper harnesses that new evaluation experience to expand the framework, with additional features, such as stratification, to examine subgroups most likely to experience improvement if control programs are working; the use of a national platform framework; and analysis of complete birth histories from national household surveys. The refined framework has shown that, despite persisting data challenges, combining multiple sources of data, considering potential contributions from both fundamental and proximate contextual factors, and conducting subnational analyses allows identification of the plausible contributions of malaria control interventions on malaria morbidity and mortality.
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Affiliation(s)
- Yazoume Yé
- MEASURE Evaluation, ICF, Rockville, Maryland
| | - Thomas P Eisele
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Erin Eckert
- President's Malaria Initiative, Bureau for Global Health, United States Agency for International Development, Washington, District of Columbia
| | - Eline Korenromp
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Avenir Health, Geneva, Switzerland
| | - Jui A Shah
- MEASURE Evaluation, ICF, Rockville, Maryland
| | - Christine L Hershey
- President's Malaria Initiative, Bureau for Global Health, United States Agency for International Development, Washington, District of Columbia
| | | | - Holly Newby
- Independent Consultant based on Stockholm, Sweden
| | - Liliana Carvajal-Velez
- Division of Data, Research, and Policy, Data and Analytics Section, United Nations Children's Fund, New York, New York
| | - Michael Lynch
- President's Malaria Initiative, Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ryuichi Komatsu
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | | | | | - Achuyt Bhattarai
- President's Malaria Initiative, Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
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4
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Cibulskis RE. Increasing the Impact of Impact Evaluation. Am J Trop Med Hyg 2017; 97:1. [PMID: 28990916 PMCID: PMC5619940 DOI: 10.4269/ajtmh.17-0600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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Bennett A, Bisanzio D, Yukich JO, Mappin B, Fergus CA, Lynch M, Cibulskis RE, Bhatt S, Weiss DJ, Cameron E, Gething PW, Eisele TP. Population coverage of artemisinin-based combination treatment in children younger than 5 years with fever and Plasmodium falciparum infection in Africa, 2003-2015: a modelling study using data from national surveys. Lancet Glob Health 2017; 5:e418-e427. [PMID: 28288746 PMCID: PMC5450656 DOI: 10.1016/s2214-109x(17)30076-1] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 01/12/2017] [Accepted: 01/13/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Artemisinin-based combination therapies (ACTs) are the most effective treatment for uncomplicated Plasmodium falciparum malaria infection. A commonly used indicator for monitoring and assessing progress in coverage of malaria treatment is the proportion of children younger than 5 years with reported fever in the previous 14 days who have received an ACT. We propose an improved indicator that incorporates parasite infection status (as assessed by a rapid diagnostic test [RDT]), which is available in recent household surveys. In this study we estimated the annual proportion of children younger than 5 years with fever and a positive RDT in Africa who received an ACT in 2003-15. METHODS Our modelling study used cross-sectional data on treatment for fever and RDT status for children younger than 5 years compiled from all nationally available representative household surveys (the Malaria Indicator Surveys, Demographic and Health Surveys, and Multiple Indicator Cluster Surveys) across sub-Saharan Africa between 2003 and 2015. Estimates for the proportion of children younger than 5 years with a fever within the previous 14 days and P falciparum infection assessed by RDT who received an ACT were incorporated in a generalised additive mixed model, including data on ACT distributions, to estimate coverage across all countries and time periods. We did random effects meta-analyses to examine individual, household, and community effects associated with ACT coverage. FINDINGS We obtained data on 201 704 children younger than 5 years from 103 surveys (22 MIS, 61 DHS, and 20 MICS) across 33 countries. RDT results were available for 40 of these surveys including 40 261 (20%) children, and we predicted RDT status for the remaining 161 443 (80%) children. Our results showed that ACT coverage in children younger than 5 years with a fever and P falciparum infection increased across sub-Saharan Africa in 2003-15, but even in 2015, only 19·7% (95% CI 15·6-24·8) of children younger than 5 years with a fever and P falciparum infection received an ACT. In meta-analyses, children younger than 5 years were more likely to receive an ACT for fever and P falciparum infection if they lived in an urban area (vs rural area; odds ratio [OR] 1·18, 95% CI 1·06-1·31), had household wealth above the national median (vs wealth below the median; OR 1·26, 1·16-1·39), had a caregiver with any education (vs no education; OR 1·31, 1·22-1·41), had a household insecticide-treated net (ITN; vs no ITN; OR 1·21, 1·13-1·29), were older than 2 years (vs ≤2 years; OR 1·09, 1·01-1·17), or lived in an area with a higher mean P falciparum prevalence in children aged 2-10 years (OR 1·12, 1·02-1·23). In the subgroup of children for whom treatment was sought, those who sought treatment in the public sector were more likely to receive an ACT (vs the private sector; OR 3·18, 2·67-3·78). INTERPRETATION Despite progress during the 2003-15 malaria programme, ACT treatment for children with malaria remains unacceptably low. More work is needed at the country level to understand how health-care access, service delivery, and ACT supply might be improved to ensure appropriate treatment for all children with malaria. FUNDING US President's Malaria Initiative and Medicines for Malaria Venture.
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Affiliation(s)
- Adam Bennett
- Malaria Elimination Initiative, Global Health Group, University of San Francisco, San Francisco, CA, USA.
| | - Donal Bisanzio
- Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Joshua O Yukich
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Bonnie Mappin
- Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Michael Lynch
- World Health Organization, Geneva, Switzerland; US Centers for Disease Control, Atlanta, GA, USA
| | | | - Samir Bhatt
- Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Daniel J Weiss
- Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Ewan Cameron
- Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Peter W Gething
- Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Thomas P Eisele
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
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Howes RE, Battle KE, Mendis KN, Smith DL, Cibulskis RE, Baird JK, Hay SI. Global Epidemiology of Plasmodium vivax. Am J Trop Med Hyg 2016; 95:15-34. [PMID: 27402513 PMCID: PMC5198891 DOI: 10.4269/ajtmh.16-0141] [Citation(s) in RCA: 249] [Impact Index Per Article: 31.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 04/19/2016] [Indexed: 01/09/2023] Open
Abstract
Plasmodium vivax is the most widespread human malaria, putting 2.5 billion people at risk of infection. Its unique biological and epidemiological characteristics pose challenges to control strategies that have been principally targeted against Plasmodium falciparum Unlike P. falciparum, P. vivax infections have typically low blood-stage parasitemia with gametocytes emerging before illness manifests, and dormant liver stages causing relapses. These traits affect both its geographic distribution and transmission patterns. Asymptomatic infections, high-risk groups, and resulting case burdens are described in this review. Despite relatively low prevalence measurements and parasitemia levels, along with high proportions of asymptomatic cases, this parasite is not benign. Plasmodium vivax can be associated with severe and even fatal illness. Spreading resistance to chloroquine against the acute attack, and the operational inadequacy of primaquine against the multiple attacks of relapse, exacerbates the risk of poor outcomes among the tens of millions suffering from infection each year. Without strategies accounting for these P. vivax-specific characteristics, progress toward elimination of endemic malaria transmission will be substantially impeded.
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Affiliation(s)
- Rosalind E. Howes
- Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Oxford, United Kingdom
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio
| | - Katherine E. Battle
- Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Oxford, United Kingdom
| | - Kamini N. Mendis
- Global Malaria Program, World Health Organization, Geneva, Switzerland
| | - David L. Smith
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland
- Sanaria Institute for Global Health and Tropical Medicine, Rockville, Maryland
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | | | - J. Kevin Baird
- Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Simon I. Hay
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
- Wellcome Trust Centre for Human Genetics, University of Oxford, Roosevelt Drive, Oxford, United Kingdom
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Cibulskis RE, Alonso P, Aponte J, Aregawi M, Barrette A, Bergeron L, Fergus CA, Knox T, Lynch M, Patouillard E, Schwarte S, Stewart S, Williams R. Malaria: Global progress 2000 - 2015 and future challenges. Infect Dis Poverty 2016; 5:61. [PMID: 27282148 PMCID: PMC4901420 DOI: 10.1186/s40249-016-0151-8] [Citation(s) in RCA: 126] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 05/20/2016] [Indexed: 12/11/2022] Open
Abstract
Background 2015 was the target year for malaria goals set by the World Health Assembly and other international institutions to reduce malaria incidence and mortality. A review of progress indicates that malaria programme financing and coverage have been transformed since the beginning of the millennium, and have contributed to substantial reductions in the burden of disease. Findings Investments in malaria programmes increased by more than 2.5 times between 2005 and 2014 from US$ 960 million to US$ 2.5 billion, allowing an expansion in malaria prevention, diagnostic testing and treatment programmes. In 2015 more than half of the population of sub-Saharan Africa slept under insecticide-treated mosquito nets, compared to just 2 % in 2000. Increased availability of rapid diagnostic tests and antimalarial medicines has allowed many more people to access timely and appropriate treatment. Malaria incidence rates have decreased by 37 % globally and mortality rates by 60 % since 2000. It is estimated that 70 % of the reductions in numbers of cases in sub-Saharan Africa can be attributed to malaria interventions. Conclusions Reductions in malaria incidence and mortality rates have been made in every WHO region and almost every country. However, decreases in malaria case incidence and mortality rates were slowest in countries that had the largest numbers of malaria cases and deaths in 2000; reductions in incidence need to be greatly accelerated in these countries to achieve future malaria targets. Progress is made challenging because malaria is concentrated in countries and areas with the least resourced health systems and the least ability to pay for system improvements. Malaria interventions are nevertheless highly cost-effective and have not only led to significant reductions in the incidence of the disease but are estimated to have saved about US$ 900 million in malaria case management costs to public providers in sub-Saharan Africa between 2000 and 2014. Investments in malaria programmes can not only reduce malaria morbidity and mortality, thereby contributing to the health targets of the Sustainable Development Goals, but they can also transform the well-being and livelihood of some of the poorest communities across the globe. Electronic supplementary material The online version of this article (doi:10.1186/s40249-016-0151-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Richard E Cibulskis
- Global Malaria Programme, World Health Organization, 20 avenue Appia, 1211, Geneva 27, Switzerland.
| | - Pedro Alonso
- Global Malaria Programme, World Health Organization, 20 avenue Appia, 1211, Geneva 27, Switzerland
| | - John Aponte
- Global Malaria Programme, World Health Organization, 20 avenue Appia, 1211, Geneva 27, Switzerland
| | - Maru Aregawi
- Global Malaria Programme, World Health Organization, 20 avenue Appia, 1211, Geneva 27, Switzerland
| | - Amy Barrette
- Global Malaria Programme, World Health Organization, 20 avenue Appia, 1211, Geneva 27, Switzerland
| | - Laurent Bergeron
- Global Malaria Programme, World Health Organization, 20 avenue Appia, 1211, Geneva 27, Switzerland
| | - Cristin A Fergus
- Global Malaria Programme, World Health Organization, 20 avenue Appia, 1211, Geneva 27, Switzerland
| | - Tessa Knox
- Global Malaria Programme, World Health Organization, 20 avenue Appia, 1211, Geneva 27, Switzerland
| | - Michael Lynch
- Global Malaria Programme, World Health Organization, 20 avenue Appia, 1211, Geneva 27, Switzerland
| | - Edith Patouillard
- Global Malaria Programme, World Health Organization, 20 avenue Appia, 1211, Geneva 27, Switzerland
| | - Silvia Schwarte
- Global Malaria Programme, World Health Organization, 20 avenue Appia, 1211, Geneva 27, Switzerland
| | - Saira Stewart
- Global Malaria Programme, World Health Organization, 20 avenue Appia, 1211, Geneva 27, Switzerland
| | - Ryan Williams
- Global Malaria Programme, World Health Organization, 20 avenue Appia, 1211, Geneva 27, Switzerland
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Griffin JT, Bhatt S, Sinka ME, Gething PW, Lynch M, Patouillard E, Shutes E, Newman RD, Alonso P, Cibulskis RE, Ghani AC. Potential for reduction of burden and local elimination of malaria by reducing Plasmodium falciparum malaria transmission: a mathematical modelling study. Lancet Infect Dis 2016; 16:465-72. [PMID: 26809816 PMCID: PMC5206792 DOI: 10.1016/s1473-3099(15)00423-5] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 10/05/2015] [Accepted: 10/27/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Rapid declines in malaria prevalence, cases, and deaths have been achieved globally during the past 15 years because of improved access to first-line treatment and vector control. We aimed to assess the intervention coverage needed to achieve further gains over the next 15 years. METHODS We used a mathematical model of the transmission of Plasmodium falciparum malaria to explore the potential effect on case incidence and malaria mortality rates from 2015 to 2030 of five different intervention scenarios: remaining at the intervention coverage levels of 2011-13 (Sustain), for which coverage comprises vector control and access to treatment; two scenarios of increased coverage to 80% (Accelerate 1) and 90% (Accelerate 2), with a switch from quinine to injectable artesunate for management of severe disease and seasonal malaria chemoprevention where recommended for both Accelerate scenarios, and rectal artesunate for pre-referral treatment at the community level added to Accelerate 2; a near-term innovation scenario (Innovate), which included longer-lasting insecticidal nets and expansion of seasonal malaria chemoprevention; and a reduction in coverage to 2006-08 levels (Reverse). We did the model simulations at the first administrative level (ie, state or province) for the 80 countries with sustained stable malaria transmission in 2010, accounting for variations in baseline endemicity, seasonality in transmission, vector species, and existing intervention coverage. To calculate the cases and deaths averted, we compared the total number of each under the five scenarios between 2015 and 2030 with the predicted number in 2015, accounting for population growth. FINDINGS With an increase to 80% coverage, we predicted a reduction in case incidence of 21% (95% credible intervals [CrI] 19-29) and a reduction in mortality rates of 40% (27-61) by 2030 compared with 2015 levels. Acceleration to 90% coverage and expansion of treatment at the community level was predicted to reduce case incidence by 59% (Crl 56-64) and mortality rates by 74% (67-82); with additional near-term innovation, incidence was predicted to decline by 74% (70-77) and mortality rates by 81% (76-87). These scenarios were predicted to lead to local elimination in 13 countries under the Accelerate 1 scenario, 20 under Accelerate 2, and 22 under Innovate by 2030, reducing the proportion of the population living in at-risk areas by 36% if elimination is defined at the first administrative unit. However, failing to maintain coverage levels of 2011-13 is predicted to raise case incidence by 76% (Crl 71-80) and mortality rates by 46% (39-51) by 2020. INTERPRETATION Our findings show that decreases in malaria transmission and burden can be accelerated over the next 15 years if the coverage of key interventions is increased. FUNDING UK Medical Research Council, UK Department for International Development, the Bill & Melinda Gates Foundation, the Swiss Development Agency, and the US Agency for International Development.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Azra C Ghani
- Medical Research Council Centre for Outbreak Analysis and Modelling, Imperial College London, London, UK.
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Zhou SS, Zhang SS, Zhang L, Rietveld AEC, Ramsay AR, Zachariah R, Bissell K, Van den Bergh R, Xia ZG, Zhou XN, Cibulskis RE. China's 1-3-7 surveillance and response strategy for malaria elimination: Is case reporting, investigation and foci response happening according to plan? Infect Dis Poverty 2015; 4:55. [PMID: 26654106 PMCID: PMC4674909 DOI: 10.1186/s40249-015-0089-2] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 11/25/2015] [Indexed: 12/21/2022] Open
Abstract
Background The China’s 1-3-7 strategy was initiated and extensively adopted in different types of counties (geographic regions) for reporting of malaria cases within 1 day, their confirmation and investigation within 3 days, and the appropriate public health response to prevent further transmission within 7 days. Assessing the level of compliance to the 1-3-7 strategy at the county level is a first step towards determining whether the surveillance and response strategy is happening according to plan. This study assessed if the time-bound targets of the 1-3-7 strategy were being sustained over time. Such information would be useful to improve implementation of the 1-3-7 strategy in China. Methods This cross-sectional study involved country-wide programmatic data for the period January 1st 2013 to June 30th 2014. Data variables were extracted from the national malaria information system and included socio-demographic information, type of county, date of diagnosis, date of reporting, date of case investigation, case classification (indigenous, or imported, or unknown), focus investigation, date of reactive case detection (RACD), and date of indoor residual spraying (IRS). Summary statistics and proportions were used and comparisons between groups were assessed using the chi-square test. Level of significance was set at a P-value ≤ 0.05. Results Of a total of 5,688 malaria cases from 731 counties, there were 55 (1 %) indigenous cases (only in Type 1 and Type 2 counties) and 5,633 (99 %) imported cases from all types of counties. There was no delay in reporting malaria cases by type of county. In terms of case investigation, 97.5 % cases were investigated within 3 days with the proportion of delays (1.5 %) in type 2 counties, being significantly lower than type 1 counties (4.1 %). Regarding active foci, 96.4 % were treated by RACD and/or IRS. Conclusions The performance of 1-3-7 strategy was encouraging but identified some challenges that if addressed can further improve implementation. Electronic supplementary material The online version of this article (doi:10.1186/s40249-015-0089-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shui-Sen Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; Key Laboratory of Parasite and Vector Biology, MOH; WHO Collaborating Centre for Tropic Diseases, National Center for International Research on Tropical Diseases, 207 Rui Jin Er Road, Shanghai,, 200025, People's Republic of China.
| | - Shao-Sen Zhang
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; Key Laboratory of Parasite and Vector Biology, MOH; WHO Collaborating Centre for Tropic Diseases, National Center for International Research on Tropical Diseases, 207 Rui Jin Er Road, Shanghai,, 200025, People's Republic of China.
| | - Li Zhang
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; Key Laboratory of Parasite and Vector Biology, MOH; WHO Collaborating Centre for Tropic Diseases, National Center for International Research on Tropical Diseases, 207 Rui Jin Er Road, Shanghai,, 200025, People's Republic of China.
| | - Aafje E C Rietveld
- Global Malaria Programme, World Health Organization, 20 Avenue Appia, CH-1211, Geneva, 27, Switzerland.
| | - Andrew R Ramsay
- Special Programme for Research and Training in Tropical Diseases (TDR), 20 Avenue Appia, CH-1211, Geneva, 27, Switzerland.
| | - Rony Zachariah
- Médecins Sans Frontieres, Brussels Operational Centre, Luxembourg, Luxembourg.
| | - Karen Bissell
- International Union Against Tuberculosis and Lung Disease, Paris, France.
| | | | - Zhi-Gui Xia
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; Key Laboratory of Parasite and Vector Biology, MOH; WHO Collaborating Centre for Tropic Diseases, National Center for International Research on Tropical Diseases, 207 Rui Jin Er Road, Shanghai,, 200025, People's Republic of China.
| | - Xiao-Nong Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; Key Laboratory of Parasite and Vector Biology, MOH; WHO Collaborating Centre for Tropic Diseases, National Center for International Research on Tropical Diseases, 207 Rui Jin Er Road, Shanghai,, 200025, People's Republic of China.
| | - Richard E Cibulskis
- Global Malaria Programme, World Health Organization, 20 Avenue Appia, CH-1211, Geneva, 27, Switzerland.
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Bhatt S, Weiss DJ, Mappin B, Dalrymple U, Cameron E, Bisanzio D, Smith DL, Moyes CL, Tatem AJ, Lynch M, Fergus CA, Yukich J, Bennett A, Eisele TP, Kolaczinski J, Cibulskis RE, Hay SI, Gething PW. Coverage and system efficiencies of insecticide-treated nets in Africa from 2000 to 2017. eLife 2015; 4:e09672. [PMID: 26714109 PMCID: PMC4758960 DOI: 10.7554/elife.09672] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 11/26/2015] [Indexed: 11/18/2022] Open
Abstract
Insecticide-treated nets (ITNs) for malaria control are widespread but coverage remains inadequate. We developed a Bayesian model using data from 102 national surveys, triangulated against delivery data and distribution reports, to generate year-by-year estimates of four ITN coverage indicators. We explored the impact of two potential 'inefficiencies': uneven net distribution among households and rapid rates of net loss from households. We estimated that, in 2013, 21% (17%-26%) of ITNs were over-allocated and this has worsened over time as overall net provision has increased. We estimated that rates of ITN loss from households are more rapid than previously thought, with 50% lost after 23 (20-28) months. We predict that the current estimate of 920 million additional ITNs required to achieve universal coverage would in reality yield a lower level of coverage (77% population access). By improving efficiency, however, the 920 million ITNs could yield population access as high as 95%.
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Affiliation(s)
- Samir Bhatt
- Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Oxford, United Kingdom
| | - Daniel J Weiss
- Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Oxford, United Kingdom
| | - Bonnie Mappin
- Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Oxford, United Kingdom
| | - Ursula Dalrymple
- Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Oxford, United Kingdom
| | - Ewan Cameron
- Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Oxford, United Kingdom
| | - Donal Bisanzio
- Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Oxford, United Kingdom
| | - David L Smith
- Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Oxford, United Kingdom,Sanaria Institute of Global Health and Tropical Medicine, Rockville, United States,Fogarty International Center, National Institutes of Health, Bethesda, United States
| | - Catherine L Moyes
- Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Oxford, United Kingdom
| | - Andrew J Tatem
- Fogarty International Center, National Institutes of Health, Bethesda, United States,Flowminder Foundation, Stockholm, Sweden,Department of Geography and the Environment, University of Southampton, Southampton, United Kingdom
| | - Michael Lynch
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | - Cristin A Fergus
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | - Joshua Yukich
- Center for Applied Malaria Research and Evaluation, Department of Global Health Systems and Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, United States
| | - Adam Bennett
- Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, San Francisco, United States
| | - Thomas P Eisele
- Center for Applied Malaria Research and Evaluation, Department of Global Health Systems and Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, United States
| | - Jan Kolaczinski
- Strategy, Investment and Impact Division, The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | | | - Simon I Hay
- Fogarty International Center, National Institutes of Health, Bethesda, United States,Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom,Institute for Health Metrics and Evaluation, University of Washington, Seattle, United States
| | - Peter W Gething
- Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Oxford, United Kingdom,
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Zhou SS, Rietveld AEC, Velarde-Rodriguez M, Ramsay AR, Zhang SS, Zhou XN, Cibulskis RE. Operational research on malaria control and elimination: a review of projects published between 2008 and 2013. Malar J 2014; 13:473. [PMID: 25471215 PMCID: PMC4265439 DOI: 10.1186/1475-2875-13-473] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 11/28/2014] [Indexed: 11/10/2022] Open
Abstract
A literature review for operational research on malaria control and elimination was conducted using the term 'malaria' and the definition of operational research (OR). A total of 15 886 articles related to malaria were searched between January 2008 and June 2013. Of these, 582 (3.7%) met the definition of operational research. These OR projects had been carried out in 83 different countries. Most OR studies (77%) were implemented in Africa south of the Sahara. Only 5 (1%) of the OR studies were implemented in countries in the pre-elimination or elimination phase. The vast majority of OR projects (92%) were led by international or local research institutions, while projects led by National Malaria Control Programmes (NMCP) accounted for 7.8%. With regards to the topic under investigation, the largest percentage of papers was related to vector control (25%), followed by epidemiology/transmission (16.5%) and treatment (16.3%). Only 19 (3.8%) of the OR projects were related to malaria surveillance. Strengthening the capacity of NMCPs to conduct operational research and publish its findings, and improving linkages between NMCPs and research institutes may aid progress towards malaria elimination and eventual eradication world-wide.
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Affiliation(s)
- Shui-sen Zhou
- />Global Malaria Programme, World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland
- />National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, 207 Rui Jin Er Road, Shanghai, 200025 P. R. China
| | - Aafje EC Rietveld
- />Global Malaria Programme, World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland
| | - Mar Velarde-Rodriguez
- />Global Malaria Programme, World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland
- />Barcelona Institute for Global Health Hospital Clinic, Universidad de Barcelona, Carrer Rossello 132, 502a, E-08036 Barcelona, Spain
| | - Andrew R Ramsay
- />Special Programme for Research and Training in Tropical Diseases (TDR), 20 Avenue Appia, CH-1211 Geneva 27, Switzerland
| | - Shao-sen Zhang
- />National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, 207 Rui Jin Er Road, Shanghai, 200025 P. R. China
| | - Xiao-nong Zhou
- />National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, 207 Rui Jin Er Road, Shanghai, 200025 P. R. China
| | - Richard E Cibulskis
- />Global Malaria Programme, World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland
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Gething PW, Battle KE, Bhatt S, Smith DL, Eisele TP, Cibulskis RE, Hay SI. Declining malaria in Africa: improving the measurement of progress. Malar J 2014; 13:39. [PMID: 24479555 PMCID: PMC3930350 DOI: 10.1186/1475-2875-13-39] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 01/28/2014] [Indexed: 11/29/2022] Open
Abstract
The dramatic escalation of malaria control activities in Africa since the year 2000 has increased the importance of accurate measurements of impact on malaria epidemiology and burden. This study presents a systematic review of the emerging published evidence base on trends in malaria risk in Africa and argues that more systematic, timely, and empirically-based approaches are urgently needed to track the rapidly evolving landscape of transmission.
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Affiliation(s)
- Peter W Gething
- Department of Zoology, Spatial Ecology and Epidemiology Group, Tinbergen Building, University of Oxford, South Parks Road, Oxford, UK.
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13
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Korenromp EL, Hosseini M, Newman RD, Cibulskis RE. Progress towards malaria control targets in relation to national malaria programme funding. Malar J 2013; 12:18. [PMID: 23317000 PMCID: PMC3598840 DOI: 10.1186/1475-2875-12-18] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Accepted: 12/20/2012] [Indexed: 12/02/2022] Open
Abstract
Background Malaria control has been dramatically scaled up the past decade, mainly thanks to increasing international donor financing since 2003. This study assessed progress up to 2010 towards global malaria impact targets, in relation to Global Fund, other donor and domestic malaria programme financing over 2003 to 2009. Methods Assessments used domestic malaria financing reported by national programmes, and Global Fund/OECD data on donor financing for 90 endemic low- and middle-income countries, WHO estimates of households owning one or more insecticide-treated mosquito net (ITN) for countries in sub-Saharan Africa, and WHO-estimated malaria case incidence and deaths in countries outside sub-Saharan Africa. Results Global Fund and other donor funding is concentrated in a subset of the highest endemic African countries. Outside Africa, donor funding is concentrated in those countries with highest malaria mortality and case incidence rates over the years 2000 to 2003. ITN coverage in 2010 in Africa, and declines in case and death rates per person at risk over 2004 to 2010 outside Africa, were greatest in countries with highest donor funding per person at risk, and smallest in countries with lowest donor malaria funding per person at risk. Outside Africa, all-source malaria programme funding over 2003 to 2009 per case averted ($56-5,749) or per death averted ($58,000-3,900,000) over 2004 to 2010 tended to be lower (more favourable) in countries with higher donor malaria funding per person at risk. Conclusions Increases in malaria programme funding are associated with accelerated progress towards malaria control targets. Associations between programme funding per person at risk and ITN coverage increases and declines in case and death rates suggest opportunities to maximize the impact of donor funding, by strategic re-allocation to countries with highest continued need.
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Affiliation(s)
- Eline L Korenromp
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
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14
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Eisele TP, Larsen DA, Walker N, Cibulskis RE, Yukich JO, Zikusooka CM, Steketee RW. Estimates of child deaths prevented from malaria prevention scale-up in Africa 2001-2010. Malar J 2012; 11:93. [PMID: 22455864 PMCID: PMC3350413 DOI: 10.1186/1475-2875-11-93] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Accepted: 03/28/2012] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Funding from external agencies for malaria control in Africa has increased dramatically over the past decade resulting in substantial increases in population coverage by effective malaria prevention interventions. This unprecedented effort to scale-up malaria interventions is likely improving child survival and will likely contribute to meeting Millennium Development Goal (MDG) 4 to reduce the < 5 mortality rate by two thirds between 1990 and 2015. METHODS The Lives Saved Tool (LiST) model was used to quantify the likely impact that malaria prevention intervention scale-up has had on malaria mortality over the past decade (2001-2010) across 43 malaria endemic countries in sub-Saharan African. The likely impact of ITNs and malaria prevention interventions in pregnancy (intermittent preventive treatment [IPTp] and ITNs used during pregnancy) over this period was assessed. RESULTS The LiST model conservatively estimates that malaria prevention intervention scale-up over the past decade has prevented 842,800 (uncertainty: 562,800-1,364,645) child deaths due to malaria across 43 malaria-endemic countries in Africa, compared to a baseline of the year 2000. Over the entire decade, this represents an 8.2% decrease in the number of malaria-caused child deaths that would have occurred over this period had malaria prevention coverage remained unchanged since 2000. The biggest impact occurred in 2010 with a 24.4% decrease in malaria-caused child deaths compared to what would have happened had malaria prevention interventions not been scaled-up beyond 2000 coverage levels. ITNs accounted for 99% of the lives saved. CONCLUSIONS The results suggest that funding for malaria prevention in Africa over the past decade has had a substantial impact on decreasing child deaths due to malaria. Rapidly achieving and then maintaining universal coverage of these interventions should be an urgent priority for malaria control programmes in the future. Successful scale-up in many African countries will likely contribute substantially to meeting MDG 4, as well as succeed in meeting MDG 6 (Target 1) to halt and reverse malaria incidence by 2015.
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Affiliation(s)
- Thomas P Eisele
- Department of Global Health Systems and Development, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2200, New Orleans, LA 70112, USA
| | - David A Larsen
- Department of Global Health Systems and Development, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2200, New Orleans, LA 70112, USA
| | - Neff Walker
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615N. Wolfe Street, Baltimore, Maryland 21205, USA
| | | | - Joshua O Yukich
- Department of Global Health Systems and Development, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2200, New Orleans, LA 70112, USA
| | | | - Richard W Steketee
- Malaria Control and Evaluation Partnership in Africa (MACEPA), a program at PATH, 2001 Westlake Ave, Seattle, WA, USA
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16
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Cibulskis RE, Pujari S, Otten MW. Do estimates of intervention coverage obtained from children at immunization clinics provide a reasonable approximation to population values? J Infect Dis 2012; 205 Suppl 1:S91-102. [PMID: 22315392 DOI: 10.1093/infdis/jir795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The purpose of this study was to determine whether the magnitude of selection bias incurred by measuring child survival intervention coverage at convenient sampling opportunities (child immunization contacts) is sufficiently small for the approach to be used as a management tool within country programs. METHODS We estimated the magnitude of selection bias by calculating values of 13 health indicators for 31 countries using Demographic and Health Survey data for children immunized with the third dose of the diphtheria-pertussis-tetanus vaccine (DPT3) and those who were immunized with measles vaccine, and comparing their values to those obtained for the population as a whole. RESULTS Estimates of intervention coverage derived from immunized children are close to population values if immunization coverage exceeds 60%. Levels of bias were lower for interventions that were not delivered directly by formal health services, such as use of mosquito nets among children and provision of more fluid for diarrhea. Levels of bias were also lower when using results for measles vaccine than for DPT3, suggesting that the measles vaccination contact may be the most opportune time to collect data on additional health indicators. CONCLUSIONS The coverage of immunization programs has reached 60% in 85% of African countries, so selection bias does not appear to invalidate the measurement of intervention coverage at immunization contacts.
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Flaxman AD, Fullman N, Otten MW, Menon M, Cibulskis RE, Ng M, Murray CJL, Lim SS. Rapid scaling up of insecticide-treated bed net coverage in Africa and its relationship with development assistance for health: a systematic synthesis of supply, distribution, and household survey data. PLoS Med 2010; 7:e1000328. [PMID: 20808957 PMCID: PMC2923089 DOI: 10.1371/journal.pmed.1000328] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Accepted: 07/09/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Development assistance for health (DAH) targeted at malaria has risen exponentially over the last 10 years, with a large fraction of these resources directed toward the distribution of insecticide-treated bed nets (ITNs). Identifying countries that have been successful in scaling up ITN coverage and understanding the role of DAH is critical for making progress in countries where coverage remains low. Sparse and inconsistent sources of data have prevented robust estimates of the coverage of ITNs over time. METHODS AND PRINCIPAL FINDINGS We combined data from manufacturer reports of ITN deliveries to countries, National Malaria Control Program (NMCP) reports of ITNs distributed to health facilities and operational partners, and household survey data using Bayesian inference on a deterministic compartmental model of ITN distribution. For 44 countries in Africa, we calculated (1) ITN ownership coverage, defined as the proportion of households that own at least one ITN, and (2) ITN use in children under 5 coverage, defined as the proportion of children under the age of 5 years who slept under an ITN. Using regression, we examined the relationship between cumulative DAH targeted at malaria between 2000 and 2008 and the change in national-level ITN coverage over the same time period. In 1999, assuming that all ITNs are owned and used in populations at risk of malaria, mean coverage of ITN ownership and use in children under 5 among populations at risk of malaria were 2.2% and 1.5%, respectively, and were uniformly low across all 44 countries. In 2003, coverage of ITN ownership and use in children under 5 was 5.1% (95% uncertainty interval 4.6% to 5.7%) and 3.7% (2.9% to 4.9%); in 2006 it was 17.5% (16.4% to 18.8%) and 12.9% (10.8% to 15.4%); and by 2008 it was 32.8% (31.4% to 34.4%) and 26.6% (22.3% to 30.9%), respectively. In 2008, four countries had ITN ownership coverage of 80% or greater; six countries were between 60% and 80%; nine countries were between 40% and 60%; 12 countries were between 20% and 40%; and 13 countries had coverage below 20%. Excluding four outlier countries, each US$1 per capita in malaria DAH was associated with a significant increase in ITN household coverage and ITN use in children under 5 coverage of 5.3 percentage points (3.7 to 6.9) and 4.6 percentage points (2.5 to 6.7), respectively. CONCLUSIONS Rapid increases in ITN coverage have occurred in some of the poorest countries, but coverage remains low in large populations at risk. DAH targeted at malaria can lead to improvements in ITN coverage; inadequate financing may be a reason for lack of progress in some countries. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Abraham D. Flaxman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Nancy Fullman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Mac W. Otten
- Surveillance, Monitoring, and Evaluation, Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | - Manoj Menon
- Malaria Branch, Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Richard E. Cibulskis
- Surveillance, Monitoring, and Evaluation, Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | - Marie Ng
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Christopher J. L. Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Stephen S. Lim
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
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Rowe AK, Steketee RW, Arnold F, Wardlaw T, Basu S, Bakyaita N, Lama M, Winston CA, Lynch M, Cibulskis RE, Shibuya K, Ratcliffe AA, Nahlen BL. Viewpoint: evaluating the impact of malaria control efforts on mortality in sub-Saharan Africa. Trop Med Int Health 2008; 12:1524-39. [PMID: 18076561 DOI: 10.1111/j.1365-3156.2007.01961.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe an approach for evaluating the impact of malaria control efforts on malaria-associated mortality in sub-Saharan Africa, where disease-specific mortality trends usually cannot be measured directly and most malaria deaths occur among young children. METHODS Methods for evaluating changes in malaria-associated mortality are examined; advantages and disadvantages are presented. RESULTS All methods require a plausibility argument-i.e., an assumption that mortality reductions can be attributed to programmatic efforts if improvements are found in steps of the causal pathway between intervention scale-up and mortality trends. As different methods provide complementary information, they can be used together. We recommend following trends in the coverage of malaria control interventions, other factors influencing childhood mortality, malaria-associated morbidity (especially anaemia), and all-cause childhood mortality. This approach reflects decreases in malaria's direct and indirect mortality burden and can be examined in nearly all countries. Adding other information can strengthen the plausibility argument: trends in indicators of malaria transmission, information from demographic surveillance systems and sentinel sites where malaria diagnostics are systematically used, and verbal autopsies linked to representative household surveys. Health facility data on malaria deaths have well-recognized limitations; however, in specific circumstances, they could produce reliable trends. Model-based predictions can help describe changes in malaria-specific burden and assist with program management and advocacy. CONCLUSIONS Despite challenges, efforts to reduce malaria-associated mortality in Africa can be evaluated with trends in malaria intervention coverage and all-cause childhood mortality. Where there are resources and interest, complementary data on malaria morbidity and malaria-specific mortality could be added.
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Affiliation(s)
- Alexander K Rowe
- Malaria Branch, Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.
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Cibulskis RE, Bell D, Christophel EM, Hii J, Delacollette C, Bakyaita N, Aregawi MW. Estimating trends in the burden of malaria at country level. Am J Trop Med Hyg 2007; 77:133-137. [PMID: 18165485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
National disease burdens are often not estimated at all or are estimated using inaccurate methods, partly because the data sources for assessing disease burden-nationally representative household surveys, demographic surveillance sites, and routine health information systems-each have their limitations. An important step forward would be a more consistent quantification of the population at risk of malaria. This is most likely to be achieved by delimiting the geographical distribution of malaria transmission using routinely collected data on confirmed cases of disease. However, before routinely collected data can be used to assess trends in the incidence of clinical cases and deaths, the incompleteness of reporting and variation in the utilization of the health system must be taken into account. In the future, sentinel surveillance from public and private health facilities, selected according to risk stratification, combined with occasional household surveys and other population-based methods of surveillance, may provide better assessments of malaria trends.
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Affiliation(s)
- Richard E Cibulskis
- Global Malaria Program, World Health Organization, 20 Avenue Appia, Geneva, Switzerland.
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20
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Cibulskis RE, Bell D, Christophel EM, Hii J, Delacollette C, Bakyaita N, Aregawi MW. Estimating Trends in the Burden of Malaria at Country Level. Am J Trop Med Hyg 2007. [DOI: 10.4269/ajtmh.77.6.suppl.133] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Richard E. Cibulskis
- World Health Organization, Global Malaria Program, Geneva, Switzerland; World Health Organization, Regional Office for the Western Pacific, Manila, Philippines; World Health Organization, Honiara, Solomon Islands; World Health Organization, Mekong Malaria Office, Bangkok, Thailand; World Health Organization, Regional Office for Africa, Harare, Zimbabwe
| | - David Bell
- World Health Organization, Global Malaria Program, Geneva, Switzerland; World Health Organization, Regional Office for the Western Pacific, Manila, Philippines; World Health Organization, Honiara, Solomon Islands; World Health Organization, Mekong Malaria Office, Bangkok, Thailand; World Health Organization, Regional Office for Africa, Harare, Zimbabwe
| | - Eva-Maria Christophel
- World Health Organization, Global Malaria Program, Geneva, Switzerland; World Health Organization, Regional Office for the Western Pacific, Manila, Philippines; World Health Organization, Honiara, Solomon Islands; World Health Organization, Mekong Malaria Office, Bangkok, Thailand; World Health Organization, Regional Office for Africa, Harare, Zimbabwe
| | - Jeffrey Hii
- World Health Organization, Global Malaria Program, Geneva, Switzerland; World Health Organization, Regional Office for the Western Pacific, Manila, Philippines; World Health Organization, Honiara, Solomon Islands; World Health Organization, Mekong Malaria Office, Bangkok, Thailand; World Health Organization, Regional Office for Africa, Harare, Zimbabwe
| | - Charles Delacollette
- World Health Organization, Global Malaria Program, Geneva, Switzerland; World Health Organization, Regional Office for the Western Pacific, Manila, Philippines; World Health Organization, Honiara, Solomon Islands; World Health Organization, Mekong Malaria Office, Bangkok, Thailand; World Health Organization, Regional Office for Africa, Harare, Zimbabwe
| | - Nathan Bakyaita
- World Health Organization, Global Malaria Program, Geneva, Switzerland; World Health Organization, Regional Office for the Western Pacific, Manila, Philippines; World Health Organization, Honiara, Solomon Islands; World Health Organization, Mekong Malaria Office, Bangkok, Thailand; World Health Organization, Regional Office for Africa, Harare, Zimbabwe
| | - Maru W. Aregawi
- World Health Organization, Global Malaria Program, Geneva, Switzerland; World Health Organization, Regional Office for the Western Pacific, Manila, Philippines; World Health Organization, Honiara, Solomon Islands; World Health Organization, Mekong Malaria Office, Bangkok, Thailand; World Health Organization, Regional Office for Africa, Harare, Zimbabwe
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Cibulskis RE. Information is not only for managers. Bull World Health Organ 2005; 83:637. [PMID: 16184285 PMCID: PMC2626313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
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Korenromp EL, Miller J, Cibulskis RE, Kabir Cham M, Alnwick D, Dye C. Monitoring mosquito net coverage for malaria control in Africa: possession vs. use by children under 5 years. Trop Med Int Health 2003; 8:693-703. [PMID: 12869090 DOI: 10.1046/j.1365-3156.2003.01084.x] [Citation(s) in RCA: 116] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To investigate the strengths and weaknesses of the indicators 'proportion of households possessing mosquito net(s)' and 'proportion of children under 5 years of age who slept under a net the preceding night' for monitoring malaria control. METHODS Review of data from household surveys including demographic and health surveys in sub-Saharan African countries. RESULTS Net possession ranged among 14 surveyed regions from 0.1% to 28.5% for insecticide-treated nets (ITNs) and among 69 regions from 3.6% to 79.7% for any net. Reported use during the preceding night by children under 5 years of age was between 0% and 16% for ITNs and between 0.7% and 74.5% for any net. On average, in households owning ITN(s), 55% of children slept under it (R2 = 0.97, P < 0.001). For any net, use was -4.2% + 0.875 x possession (R2 = 0.89, P < 0.001); the use of nets, however, also varied somewhat among the surveyed countries (P = 0.003). In-depth surveys suggested that use was lower than possession because: (i). nets were scarce (mean 1.8 per possessing household); (ii). nets were not always used for children and (iii). use was lower during hot, dry months than during cool rainy months, and many surveys had been conducted in the dry season. CONCLUSIONS Not all mosquito nets owned by African households are being used for young children. Household education on the consistent use of nets for this vulnerable group is called for in malaria control programmes. Regular, district-level rapid assessments of household possession of nets should complement ongoing in-depth surveys. Data on 'use during the preceding night' must be interpreted taking the survey season into account.
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Affiliation(s)
- Eline L Korenromp
- World Health Organization, Roll Back Malaria Monitoring and Evaluation, Geneva, Switzerland.
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Cibulskis RE, Hiawalyer G. Information systems for health sector monitoring in Papua New Guinea. Bull World Health Organ 2002; 80:752-8. [PMID: 12378295 PMCID: PMC2567603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Abstract
This paper describes (i). how a national health information System was designed, tested and implemented in Papua New Guinea, (ii). how the system was integrated with other management information systems, and (iii). how information has been used to support decision-making. It concludes that central coordination of systems design is essential to make sure that information systems are aligned with government priorities and can deliver the information required by managers. While there is often scope for improving the performance of existing information systems, too much emphasis can be placed on revising data collection procedures and creating the perfect information system. Data analysis, even from imperfect systems, can stimulate greater interest in information, which can improve the quality and completeness of reporting and encourage a more methodical approach to planning and monitoring services. Our experience suggests that senior decision-makers and political leaders can play an important role in creating a culture of information use. By demanding health information, using it to formulate policy, and disseminating it through the channels open to them, they can exert greater influence in negotiations with donors and other government departments, encourage a more rational approach to decision-making that will improve the operation of health services, and stimulate greater use of information at lower levels of the health system. The ability of information systems to deliver these benefits is critical to their sustainability.
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Affiliation(s)
- R E Cibulskis
- Department of Population and International Health, Harvard School of Public Health, Boston, MA 02115, USA.
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Cibulskis RE, Posonai E, Karel SG. Initial experience of using a knowledge based system for monitoring immunization services in Papua New Guinea. J Trop Med Hyg 1995; 98:107-13. [PMID: 7714932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A knowledge based system (KBS) which helps health service managers to interpret immunization coverage rates was installed in two provinces of Papua New Guinea. It was assessed over a period of 4 months to determine whether it was a potentially useful management tool. One province used the system but did not adjust its activities significantly because it was meeting its targets for immunization. In the other province the KBS helped provincial managers to detect problems and respond to them. Consequently, improvements in performance indicators were detected. It is difficult to attribute the improvements entirely to the KBS but several actions were taken to strengthen immunization services and the KBS appeared to support these. It appears that interventions which make routinely collected data more understandable and readily usable by health service managers can lead to improvements in the delivery of health services.
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Affiliation(s)
- R E Cibulskis
- International Health Division, Liverpool School of Tropical Medicine, UK
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Cibulskis RE, Edwards KN. Quality circles and their potential application to rural health care in Papua New Guinea. P N G Med J 1993; 36:107-13. [PMID: 8154191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A quality circle is a group of service providers who meet regularly to solve problems relating to the quality of their work. This is an example of bottom-up rather than top-down management which has found considerable success in the industries of the developed world. This article describes the principles which govern the operation of quality circles, the expected benefits and how best to introduce them. The problems relating to the provision of quality health care in rural areas and the potential application of the quality circle methodology are discussed.
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Affiliation(s)
- R E Cibulskis
- Liverpool School of Tropical Medicine, United Kingdom
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Cibulskis RE, Crouch-Chivers PR, Posonai E, Moni C, Thomason JA. A knowledge-based system for monitoring immunization coverage in Papua new Guinea. Int J Health Plann Manage 1993. [DOI: 10.1002/hpm.4740080106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Cibulskis RE, Crouch-Chivers PR, Pasonai E, Moni C, Thomason JA. Knowledge-based systems for monitoring and evaluation of health services in developing countries. Lancet 1992; 339:310-1. [PMID: 1346318 DOI: 10.1016/0140-6736(92)91385-l] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
A contingency table approach was used to explore the influence of location, host species and time on the genetic composition of a Trypanosoma brucei population in Lambwe Valley, Kenya. Significant differences in zymodeme frequencies were noticed over comparatively short geographical distances suggesting that transmission of T. brucei is somewhat localized. A significant association was observed between zymodeme and the mammalian host from which T. brucei was derived. The association was consistent in different localities in Lambwe valley and remained stable for at least 32 months. These observations indicate that zymodemes are adapted to different host species and that genetic exchange has not disrupted host associations over this time-scale. A major change in the composition of the T. brucei population during a sleeping sickness outbreak in 1980 was confirmed. But while new zymodemes emerged, a decline in overall diversity was noted during times of high sleeping sickness incidence. The results can be explained by selection of T. brucei zymodemes for particular transmission cycles. Although it is not necessary to invoke genetic exchange, sex may help T. brucei to adapt to changes in selection pressures. Such a hypothesis helps to explain why T. brucei appears largely clonal in the short term, even though population studies indicate that sex is responsible for much genetic diversity in the long term. It also explains why neighbouring populations of T. brucei are composed of a different range of zymodemes formed from the same alleles. Such a view implies that genetic exchange has an important role in the microevolution of T. brucei populations.
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Affiliation(s)
- R E Cibulskis
- Department of International Community Health, Liverpool School of Tropical Medicine, UK
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Abstract
Experimental work has established that a sexual process can occur in African trypanosomes (Jenni, Marti, Schweizer, Betschart, Le Page, Wells, Tait, Paindavoine, Pays & Steinert, 1986; Paindavoine, Zampetti-Bosseler, Pays, Schweizer, Guyaux, Jenni & Steinert, 1986; Tait, personal communication). However, the role of the process in natural populations of trypanosomes is poorly understood. This paper considers what information can be gained from analyses of isoenzyme polymorphism. A cladistic approach is used to help determine whether trypanosome diversity could have been produced by mutation alone. When applied to three East African populations of Trypanosoma brucei it provides evidence that some diversity has arisen through a sexual process; this explains the variation observed within a locality and can account for the evolution of differences between localities. However, the extent to which genetic exchange currently operates is less clear. Analysis of genotype frequencies indicates that agreements with Hardy-Weinberg expectations can be obtained even if genetic exchange exerted no influence over genotype frequencies. Moreover, analysis of joint locus frequencies reveals disequilibrium between loci and that trypanosome populations may be lacking several genotype combinations. Thus, genetic exchange may not occur sufficiently frequently, or in such a way as to break up associations between loci. The relevance of these observations to the evolution of strain differences within T. brucei is discussed.
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Affiliation(s)
- R E Cibulskis
- Department of Medical Protozoology, London School of Hygiene and Tropical Medicine
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Annett H, Cibulskis RE. Some managerial considerations. Health Policy Plan 1988. [DOI: 10.1093/heapol/3.4.334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Saravia NG, Holguín AF, Cibulskis RE, D'Alessandro A. Divergent isoenzyme profiles of sylvatic and domiciliary Trypanosoma cruzi in the eastern plains, piedmont, and highlands of Colombia. Am J Trop Med Hyg 1987; 36:59-69. [PMID: 3544893 DOI: 10.4269/ajtmh.1987.36.59] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Fifty-four stocks of Trypanosoma cruzi from vectors, mammalian reservoirs, and infected humans were characterized by enzyme electrophoresis in starch gels using Brazilian zymodeme reference strains (Z1, X-10; Z2, ESM; Z3, CAN-3) as standards. Colombian stocks were collected in three ecologically and epidemiologically distinct settings. Thirteen enzymes were included in the evaluation. Sixteen different phenotypic profiles or "zymodemes" were evident and generated three groups of closely related stocks: a sylvatic Z1-like group, a domiciliary Z1-like group, and a sylvatic Z3-like group. The number of zymodemes observed in foci of sylvatic transmission was greater than in foci of domiciliary transmission. Modified ecologic conditions associated with agriculture and the consequent reduction of biologic diversity may account for the observed pattern of zymodeme distribution and heterogeneity. The phenotypic similarity between the principal sylvatic group of stocks and domiciliary stocks contrasts with the extensive differences observed between the domestic Z2 zymodeme and sylvatic Z1 and Z3 zymodemes in Brazil and Chile.
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Affiliation(s)
- M A Miles
- Wolfson Unit/Department of Medical Protozoology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
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Flockhart HA, Cibulskis RE, Karam M, Albiez EJ. Onchocerca volvulus: enzyme polymorphism in relation to the differentiation of forest and savannah strains of this parasite. Trans R Soc Trop Med Hyg 1986; 80:285-92. [PMID: 3024365 DOI: 10.1016/0035-9203(86)90037-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Isozyme analysis was carried out on Onchocerca volvulus worms collected from Liberia, Ivory Coast, Burkina Faso and Sudan to see whether this technique could detect differences between forest and savannah populations of this parasite. A total of 243 forest and 189 savannah individual female worms were electrophoresed and stained for seven enzymes. Four showed some polymorphism, LDH, MDH, PGM and MPI and the other three, GAPDH, PEP and GPI were invariant. Statistical analysis of the results showed that the relative proportions of genotypes from within the different countries conformed to Hardy-Weinberg expectations. Pairwise comparisons of allele frequencies between countries showed that populations from Liberia and Ivory Coast had a very similar composition; there was some divergence between all the other pairs of populations and the genetic distance was calculated to summarize the degree of divergence. The number of loci examined was small and the genetic distances were within the range expected for separate geographical populations of the same species. The usefulness of this technique in worm identification is discussed.
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Abstract
Numerical analysis of 59 zymodemes of Old World Leishmania, based on the enzyme profiles of 280 stocks, revealed several distinct clusters. Some of these clusters corresponded with traditional taxonomic groupings: L. major, L. tropica, L. aethiopica and L. donovani sensu lato, but hitherto unrecognized groups were also indicated. The analysis provided an overview of the interrelationships between the Leishmania zymodemes.
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