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

Malaria Journal

Research

Dolorès Pourette¹  Laurence Randrianasolo²  Patrice Piola²  Florian Girond²  Emma Raboanary²  Vaomalala Raharimanga²  Chiarella Mattern²  Milijaona Randrianarivelojosia³  Thomas Kesteman⁴  Christophe Rogier⁵ 

[1] Centre population et développement (CEPED), Institut de Recherche pour le Développement, 19 Rue Jacob, 75006, Paris, France;Université Catholique de Madagascar, Antananarivo, Madagascar;Epidemiology Unit, Institut Pasteur de Madagascar, BP 1274, Antananarivo, 101, Avaradoha, Madagascar;Malaria Research Unit, Institut Pasteur de Madagascar, BP 1274, Antananarivo 101, Avaradoha, Madagascar;Malaria Research Unit, Institut Pasteur de Madagascar, BP 1274, Antananarivo 101, Avaradoha, Madagascar;Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE), UMR 6236, 27 Boulevard Jean Moulin, 13385, Marseille, Cedex 05, France;Malaria Research Unit, Institut Pasteur de Madagascar, BP 1274, Antananarivo 101, Avaradoha, Madagascar;Unité de recherche sur les maladies infectieuses et tropicales émergentes (URMITE), UMR 6236, 27 Boulevard Jean Moulin, 13385, Marseille, Cedex 05, France;Institute for Biomedical Research of the French Armed Forces (IRBA), BP 73, 91223, Brétigny-Sur-Orge, Cedex, France;

关键词: Malaria;    Mortality;    Morbidity;    Prevalence;    Prevention and control;    Cross-sectional studies;    Health surveys;    Vector control;    Insecticide-treated bed nets;    Case management;   

DOI  :  10.1186/1475-2875-13-465

 received in 2014-09-30, accepted in 2014-11-18,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundIn the last decade, an important scale-up was observed in malaria control interventions. Madagascar entered the process for pre-elimination in 2007. Policy making needs operational indicators, but also indicators about effectiveness and impact of malaria control interventions (MCI). This study is aimed at providing data about malaria infection, morbidity, and mortality, and MCI in Madagascar.MethodsTwo nationwide surveys were simultaneously conducted in 2012–2013 in Madagascar: a study about non-complicated clinical malaria cases in 31 sentinel health facilities, and a cross-sectional survey (CSS) in 62 sites. The CSS encompassed interviews, collection of biological samples and verbal autopsies (VA). Data from CSS were weighted for age, sex, malaria transmission pattern, and population density. VA data were processed with InterVA-4 software.ResultsCSS included 15,746 individuals of all ages. Parasite rate (PR) as measured by rapid diagnostic tests was 3.1%, and was significantly higher in five to 19 year olds, in males, poorer socio-economic status (SES) quintiles and rural areas. Long-lasting insecticidal nets (LLIN) use was 41.7% and was significantly lower in five to 19 year olds, males and wealthier SES quintiles. Proportion of persons covered by indoor residual spraying (IRS) was 66.8% in targeted zones. Proportion of persons using other insecticides than IRS was 22.8%. Coverage of intermittent preventive treatment during pregnancy was 21.5%. Exposure to information, education and communication messages about malaria was significantly higher in wealthier SES for all media but information meetings. The proportion of fever case managements considered as appropriate with regard to malaria was 15.8%. Malaria was attributed as the cause of death in 14.0% of 86 VA, and 50% of these deaths involved persons above the age of five years. The clinical case study included 818 cases of which people above the age of five accounted for 79.7%. In targeted zones, coverage of LLIN and IRS were lower in clinical cases than in general population.ConclusionsThis study provides valuable data for the evaluation of effectiveness and factors affecting MCI. MCI and evaluation surveys should consider the whole population and not only focus on under-fives and pregnant women in pre-elimination or elimination strategies.

【 授权许可】

CC BY   
© Kesteman et al.; licensee BioMed Central. 2014