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Childhood malaria admission rates to four hospitals in Malawi between 2000 and 2010
Emelda A Okiro1, Lawrence N Kazembe, Caroline W Kabaria
1Malaria Public Health Department, Kenya Medical Research Institute-Wellcome Trust-University of Oxford Collaborative Programme, Nairobi, Kenya. eokiro@nairobi.kemri-wellcome.org
Insights
Despite increased malaria interventions in Malawi, paediatric clinical malaria cases showed minimal change. More data is needed across Africa to understand the impact of malaria funding and optimal intervention coverage for disease decline.
Area of Science:
- Public Health
- Infectious Disease Epidemiology
- Malariology
Background:
- Scaling up of malaria interventions in Africa has increased with development assistance.
- Limited country-specific data exists on the health impact of expanded malaria interventions.
- Malaria remains a significant public health concern in many African nations.
Purpose of the Study:
- To assess the health impact of expanded malaria interventions in Malawi.
- To determine the relationship between intervention coverage and paediatric clinical malaria admissions.
- To evaluate changes in malaria admission rates over a decade.
Main Methods:
- Paediatric admission data from four Malawian hospitals (2000-2010) were analyzed.
- Time-series models controlled for climate and service use covariates.
- Clinical malaria admission trends were compared with intervention coverage, specifically Insecticide-Treated Net (ITN) coverage.
Main Results:
- Clinical malaria admission rates increased at three of four sites.
- Two hospitals showed a significant month-to-month increase in clinical malaria admissions (trend P<0.05).
- Despite modest increases in ITN coverage (up to 33% by 2010), malaria transmission intensity remained unchanged, and disease declines were not evident.
Conclusions:
- Minimal changes in paediatric clinical malaria cases were observed despite modest increases in interventions.
- Impact surveillance is crucial in areas with increasing intervention coverage, as declines may occur when coverage reaches optimal levels.
- Further multi-site studies are needed to understand the broader implications of malaria funding and intervention effectiveness across Africa.
Introduction:
The last few years have witnessed rapid scaling-up of key malaria interventions in several African countries following increases in development assistance. However, there is only limited country-specific information on the health impact of expanded coverage of these interventions.
Methods:
Paediatric admission data were assembled from 4 hospitals in Malawi reflecting different malaria ecologies. Trends in monthly clinical malaria admissions between January 2000 and December 2010 were analysed using time-series models controlling for covariates related to climate and service use to establish whether changes in admissions can be related to expanded coverage of interventions aimed at reducing malaria infection.
Results:
In 3 of 4 sites there was an increase in clinical malaria admission rates. Results from time series models indicate a significant month-to-month increase in the mean clinical malaria admission rates at two hospitals (trend P<0.05). At these hospitals clinical malaria admissions had increased from 2000 by 41% to 100%. Comparison of changes in malaria risk and ITN coverage appear to correspond to a lack of disease declines over the period. Changes in intervention coverage within hospital catchments showed minimal increases in ITN coverage from <6% across all sites in 2000 to maximum of 33% at one hospital site by 2010. Additionally, malaria transmission intensity remained unchanged between 2000-2010 across all sites.
Discussion:
Despite modest increases in coverage of measures to reduce infection there has been minimal changes in paediatric clinical malaria cases in four hospitals in Malawi. Studies across Africa are increasingly showing a mixed set of impact results and it is important to assemble more data from more sites to understand the wider implications of malaria funding investment. We also caution that impact surveillance should continue in areas where intervention coverage is increasing with time, for example Malawi, as decline may become evident within a period when coverage reaches optimal levels.
