1921
Volume 103, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

There is limited evidence on whether malaria elimination is feasible in high-transmission areas of Africa. Between 2007 and 2018, we measured the impact of malaria control interventions in young children enrolled in three clinical trials and two observational studies in Tororo, Uganda, a historically high-transmission area. Data were pooled from children aged 0.5–2 years. Interventions included individually assigned chemoprevention and repeated rounds of indoor residual spraying (IRS) of insecticide. All children received long-lasting insecticidal nets (LLINs) and treatment for symptomatic malaria with artemisinin-based combination therapy. Malaria incidence was measured using passive surveillance and parasite prevalence by microscopy and molecular methods at regular intervals. Poisson’s generalized linear mixed-effects models were used to estimate the impact of various control interventions. In total, 939 children were followed over 1,221.7 person years. In the absence of chemoprevention and IRS (reference group), malaria incidence was 4.94 episodes per person year and parasite prevalence 47.3%. Compared with the reference group, implementation of IRS was associated with a 97.6% decrease (95% CI: 93.3–99.1%, = 0.001) in the incidence of malaria and a 96.0% decrease (95% CI: 91.3–98.2%, < 0.001) in parasite prevalence (both measured after the fifth and sixth rounds of IRS). The addition of chemoprevention with monthly dihydroartemisinin–piperaquine to IRS was associated with a 99.5% decrease (95% CI: 98.6–99.9%, < 0.001) in the incidence of malaria. In a historically high–malaria burden area of Uganda, a combination of LLINs, effective case management, IRS, and chemoprevention was associated with almost complete elimination of malaria in young children.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution (CC-BY) License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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References

  1. The Lancet, 2009 Maintaining momentum for malaria elimination. Lancet 374: 266.
    [Google Scholar]
  2. Mendis K, Rietveld A, Warsame M, Bosman A, Greenwood B, Wernsdorfer WH, 2009. From malaria control to eradication: the WHO perspective. Trop Med Int Health 14: 802809.
    [Google Scholar]
  3. Feachem RG et al., 2010. Shrinking the malaria map: progress and prospects. Lancet 376: 15661578.
    [Google Scholar]
  4. World Health Organization, 2019. World Malaria Report 2019. Geneva, Switzerland: WHO.
    [Google Scholar]
  5. Bhattarai A et al., 2007. Impact of artemisinin-based combination therapy and insecticide-treated nets on malaria burden in Zanzibar. PLoS Med 4: e309.
    [Google Scholar]
  6. O’Meara WP, Mangeni JN, Steketee R, Greenwood B, 2010. Changes in the burden of malaria in sub-Saharan Africa. Lancet Infect Dis 10: 545555.
    [Google Scholar]
  7. Trape JF et al., 2012. New malaria-control policies and child mortality in Senegal: reaching millennium development goal 4. J Infect Dis 205: 672679.
    [Google Scholar]
  8. Bjorkman A et al., 2019. From high to low malaria transmission in Zanzibar-challenges and opportunities to achieve elimination. BMC Med 17: 14.
    [Google Scholar]
  9. Trape JF et al., 2014. The rise and fall of malaria in a West African rural community, Dielmo, Senegal, from 1990 to 2012: a 22 year longitudinal study. Lancet Infect Dis 14: 476488.
    [Google Scholar]
  10. Moonen B et al., 2010. Operational strategies to achieve and maintain malaria elimination. Lancet 376: 15921603.
    [Google Scholar]
  11. Uganda Bureau of Statistics, 2015. Uganda Malaria Indicator Survey 2014–15. Available at: https://dhsprogram.com/pubs/pdf/MIS21/MIS21.pdf. Accessed March 21, 2020.
    [Google Scholar]
  12. Katureebe A et al., 2016. Measures of malaria burden after long-lasting insecticidal net distribution and indoor residual spraying at three sites in Uganda: a prospective observational study. PLoS Med 13: e1002167.
    [Google Scholar]
  13. Kigozi R et al., 2012. Indoor residual spraying of insecticide and malaria morbidity in a high transmission intensity area of Uganda. PLoS One 7: e42857.
    [Google Scholar]
  14. Raouf S et al., 2017. Resurgence of malaria following discontinuation of indoor residual spraying of insecticide in an area of Uganda with previously high-transmission intensity. Clin Infect Dis 65: 453460.
    [Google Scholar]
  15. Kamya MR et al., 2015. Malaria transmission, infection, and disease at three sites with varied transmission intensity in Uganda: implications for malaria control. Am J Trop Med Hyg 92: 903912.
    [Google Scholar]
  16. Arinaitwe E et al., 2009. Artemether-lumefantrine versus dihydroartemisinin-piperaquine for falciparum malaria: a longitudinal, randomized trial in young Ugandan children. Clin Infect Dis 49: 16291637.
    [Google Scholar]
  17. Bigira V et al., 2014. Protective efficacy and safety of three antimalarial regimens for the prevention of malaria in young Ugandan children: a randomized controlled trial. PLoS Med 11: e1001689.
    [Google Scholar]
  18. Jagannathan P et al., 2018. Dihydroartemisinin-piperaquine for intermittent preventive treatment of malaria during pregnancy and risk of malaria in early childhood: a randomized controlled trial. PLoS Med 15: e1002606.
    [Google Scholar]
  19. Wanzira H, Kakuru A, Arinaitwe E, Bigira V, Muhindo MK, Conrad M, Rosenthal PJ, Kamya MR, Tappero JW, Dorsey G, 2014. Longitudinal outcomes in a cohort of Ugandan children randomized to artemether-lumefantrine versus dihydroartemisinin-piperaquine for the treatment of malaria. Clin Infect Dis 59: 509516.
    [Google Scholar]
  20. Musiime AK et al., 2019. Impact of vector control interventions on malaria transmission intensity, outdoor vector biting rates and Anopheles mosquito species composition in Tororo, Uganda. Malar J 18: 445.
    [Google Scholar]
  21. Okia M, Hoel DF, Kirunda J, Rwakimari JB, Mpeka B, Ambayo D, Price A, Oguttu DW, Okui AP, Govere J, 2018. Insecticide resistance status of the malaria mosquitoes: Anopheles gambiae and Anopheles funestus in eastern and northern Uganda. Malar J 17: 157.
    [Google Scholar]
  22. Hopkins H et al., 2013. Highly sensitive detection of malaria parasitemia in a malaria-endemic setting: performance of a new loop-mediated isothermal amplification kit in a remote clinic in Uganda. J Infect Dis 208: 645652.
    [Google Scholar]
  23. Hofmann N, Mwingira F, Shekalaghe S, Robinson LJ, Mueller I, Felger I, 2015. Ultra-sensitive detection of Plasmodium falciparum by amplification of multi-copy subtelomeric targets. PLoS Med 12: e1001788.
    [Google Scholar]
  24. Mabaso ML, Sharp B, Lengeler C, 2004. Historical review of malarial control in southern African with emphasis on the use of indoor residual house-spraying. Trop Med Int Health 9: 846856.
    [Google Scholar]
  25. Najera JA, Gonzalez-Silva M, Alonso PL, 2011. Some lessons for the future from the global malaria eradication programme (1955–1969). PLoS Med 8: e1000412.
    [Google Scholar]
  26. Corbel V et al., 2012. Combination of malaria vector control interventions in pyrethroid resistance area in Benin: a cluster randomised controlled trial. Lancet Infect Dis 12: 617626.
    [Google Scholar]
  27. Fullman N, Burstein R, Lim SS, Medlin C, Gakidou E, 2013. Nets, spray or both? The effectiveness of insecticide-treated nets and indoor residual spraying in reducing malaria morbidity and child mortality in sub-Saharan Africa. Malar J 12: 62.
    [Google Scholar]
  28. Hamel MJ, Otieno P, Bayoh N, Kariuki S, Were V, Marwanga D, Laserson KF, Williamson J, Slutsker L, Gimnig J, 2011. The combination of indoor residual spraying and insecticide-treated nets provides added protection against malaria compared with insecticide-treated nets alone. Am J Trop Med Hyg 85: 10801086.
    [Google Scholar]
  29. Pinder M et al., 2015. Efficacy of indoor residual spraying with dichlorodiphenyltrichloroethane against malaria in Gambian communities with high usage of long-lasting insecticidal mosquito nets: a cluster-randomised controlled trial. Lancet 385: 14361446.
    [Google Scholar]
  30. Oxborough RM, 2016. Trends in US President’s malaria initiative-funded indoor residual spray coverage and insecticide choice in sub-Saharan Africa (2008–2015): urgent need for affordable, long-lasting insecticides. Malar J 15: 146.
    [Google Scholar]
  31. Odokonyero TAE, Ssengooba F, 2019. Financing Indoor Residual Spraying for Malaria Prevention in Uganda: Options for Cost Minimization. Kampala, Uganda: Economic Policy Research Centre.
    [Google Scholar]
  32. Greenwood B, 2017. New tools for malaria control - using them wisely. J Infect 74 (Suppl 1): S23S26.
    [Google Scholar]
  33. Eisele TP et al., 2016. Short-term impact of mass drug administration with dihydroartemisinin plus piperaquine on malaria in southern province Zambia: a cluster-randomized controlled trial. J Infect Dis 214: 18311839.
    [Google Scholar]
  34. Morris U et al., 2018. A cluster randomised controlled trial of two rounds of mass drug administration in Zanzibar, a malaria pre-elimination setting-high coverage and safety, but no significant impact on transmission. BMC Med 16: 215.
    [Google Scholar]
  35. Bhatt S et al., 2015. The effect of malaria control on Plasmodium falciparum in Africa between 2000 and 2015. Nature 526: 207211.
    [Google Scholar]
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  • Received : 06 Feb 2020
  • Accepted : 11 Apr 2020
  • Published online : 18 May 2020
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