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Malaria elimination: the factors that hinders the progress to quick elimination; a meta analysis.

By Pierre Bush, PhD Moderator | 24 Jun, 2017

Dear Colleagues,
I have a project and I am inviting those who are willing to collaborate to come forward. Most of it involves literature review. You may post the pertinent material under this discussion. The project can also be found on researchgate. Thank you.
Here is the summary:

During the last century, the countries in the western hemisphere have succeeded to eliminate malaria. As of today, over 90 countries are malaria endemic. Several of these countries are on the path of eliminating malaria by 2030. Others are nowhere close to the elimination goal. In fact, during the last five years there have been malaria resurgences in several African countries, despite the progress made in the reduction of malaria morbidity and mortality that was achieved due to the assistance of PMI and other donors (see attached President’s Malaria Initiative Strategy 2015–2020). The aim of this project is to examine all the factors that have contributed to the resurgence of malaria in the African countries, and finding out how these factors can be mitigated in order to get back to the path of controlling malaria and ultimately achieving its elimination.

Attached resource:



Seraphine Adibaku Replied at 1:03 PM, 25 Jun 2017

Resurgence of malaria after discontinuation of indoor residual spraying of insecticide in a previously high transmission intensity area of Uganda
Saned Raouf,ArthurMpimbaza,RuthKigozi, Asadu Sserwanga,GrantDorsey
Background In 2009, Uganda implemented a programme of indoor residual spraying of insecticide (IRS) in ten districts in the Northern Region with historically high malaria transmission intensity. This programme was successful in reducing the burden of malaria; however, in May, 2014, IRS was discontinued, to be replaced by universal distribution of long-lasting insecticide-treated bednets. The aim of this study was to assess changes in malaria morbidity during and after IRS discontinuation in one district in Uganda.
Methods We gathered individual-level malaria surveillance data from one outpatient department and one paediatric inpatient setting in Apac District. Data collected included whether malaria was suspected and the results of laboratory testing. Primary outcome was the test positivity rate (TPR), defined as the proportion of people tested who had laboratory-confirmed malaria. We evaluated temporal changes in TPR as a categorical variable, taking in to account baseline, initial period of effective IRS, sustained IRS, and discontinuation of IRS and using an interrupted time series analysis controlling for method of testing, seasonality, and autocorrelation with calendar time.
Findings Outpatient visits were recorded over a 77-month period and included 126 260 patient encounters: 67634 patients (53·6%) had suspected malaria and 65 421 (96·7%) of patients with suspected malaria underwent laboratory testing. In children under 5 years, baseline TPR was 60–80% with an initial decrease of 5∙95% per month (CI –8·46 to –3·44%, p<0·0001) after implementation of effective IRS followed by a sustained decrease of 0∙42% per month (CI –0·70 to –0·14%, p=0·004). From month 4 to month 18 after discontinuation of IRS, TPR increased by an average of 3∙30% per month (CI 1·88–4·73%, p<0·0001), eventually returning to baseline levels. Similar trends were seen in patients older than 5 years. For the 14 595 inpatient admissions, TPR increased by an average of 6∙5% per month (CI 4·34–8·66%, p<0·0001) between month 4 and month 18 after discontinuation of IRS, reaching a point where almost 100% of children tested positive for malaria.
Interpretation The discontinuation of IRS in an area with historically high transmission intensity was associated with a significant increase in malaria morbidity, reaching pre-IRS levels within 18 months, despite universal distribution of long-lasting insecticide-treated bednets. These findings have important policy implications for sustaining reductions in the burden of malaria in high transmission settings.
Funding US Centers for Disease Control and Prevention, US President’s Malaria Initiative, Doris Duke Charitable Foundation, and Alpha Omega Alpha Honor Society.
Copyright © Raouf et al. Open Access article distributed under the terms of CC BY.
Declaration of interests
We declare no competing interests.
Published Online April 8, 2016
Department of Medicine, University of California, San Francisco, CA, USA (S Raouf BS, G Dorsey MD); Uganda Malaria Surveillance Project, Kampala, Uganda (R Kigozi MPH, A Mpimbaza MBchB, A Sserwanga MBchB)
Correspondence to:
Saned Raouf, Department of Medicine, University of California, San Francisco, 1001 Potero Avenue, SFGH Building 30, San Francisco, CA 94110, USA

YAP BOUM II Replied at 1:09 PM, 25 Jun 2017

Very interesting. Thanks Séraphine !

Seraphine Adibaku Replied at 1:12 PM, 25 Jun 2017

What I have just pastes in the preceeding mail documents Uganda's experience where 5 years of sustained quality IRS implementation with PMI funding in a very high transmission area in the north saw malaria parasite prevalence  drop from 63% in 2009 to 19% in 2014. However after withdrawal of the programme malaria rebounded to pre-IRS levels. I have no access to the full publication but hope this adds to the literature review.

Pierre Bush, PhD Moderator Replied at 2:38 PM, 25 Jun 2017

Hello Seraphine,
You are the first collaborator. I will access the full text. This is a very relevant resource. Well done.
Thank you very much.
Highest regards.

Divine Bahtila Tumi Replied at 7:31 AM, 26 Jun 2017

Nice research we see them, don't know the difficult fight for malaria is
big, don't relax because it's malaria it's still deathly in Cameroon

Kavitha Saravu Replied at 10:39 AM, 26 Jun 2017

1. Malaria resurgence: a systematic review and assessment of its causes.
Cohen JM, Smith DL, Cotter C, Ward A, Yamey G, Sabot OJ, Moonen B.
Malar J. 2012 Apr 24;11:122. doi: 10.1186/1475-2875-11-122. Review.

2. Preparation for malaria resurgence in China: approach in risk assessment and rapid response.
Qian YJ, Zhang L, Xia ZG, Vong S, Yang WZ, Wang DQ, Xiao N.
Adv Parasitol. 2014;86:267-88. doi: 10.1016/B978-0-12-800869-0.00010-X. Review.

3. Preparedness for malaria resurgence in China: case study on imported cases in 2000-2012.
Feng J, Xia ZG, Vong S, Yang WZ, Zhou SS, Xiao N.
Adv Parasitol. 2014;86:231-65. doi: 10.1016/B978-0-12-800869-0.00009-3. Review.
PMID: 25476887

4. Preparation of malaria resurgence in China: case study of vivax malaria re-emergence and outbreak in Huang-Huai Plain in 2006.
Zhang HW, Liu Y, Zhang SS, Xu BL, Li WD, Tang JH, Zhou SS, Huang F.
Adv Parasitol. 2014;86:205-30. doi: 10.1016/B978-0-12-800869-0.00008-1. Review.
5. Sharma VP. Reemergence of malaria in India. Indian Journal Malaria Research.103.Jan 1996, p22-45

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Pierre Bush, PhD Moderator Replied at 5:13 PM, 26 Jun 2017

Hello Kavitha,
Thank you, I will look at these resources.
Highest regards.

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