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Effectiveness of a national mass distribution campaign of long-lasting insecticide-treated nets and indoor residual spraying on clinical malaria in Malawi, 2018-2020.
Topazian, Hillary M; Gumbo, Austin; Brandt, Katerina; Kayange, Michael; Smith, Jennifer S; Edwards, Jessie K; Goel, Varun; Mvalo, Tisungane; Emch, Michael; Pettifor, Audrey E; Juliano, Jonathan J; Hoffman, Irving.
Afiliación
  • Topazian HM; Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA hillaryt@live.unc.edu.
  • Gumbo A; National Malaria Control Programme, Malawi Ministry of Health, Lilongwe, Malawi.
  • Brandt K; Department of Geography, University of North Carolina at Chapel Hill Graduate School, Chapel Hill, North Carolina, USA.
  • Kayange M; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
  • Smith JS; National Malaria Control Programme, Malawi Ministry of Health, Lilongwe, Malawi.
  • Edwards JK; Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA.
  • Goel V; Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA.
  • Mvalo T; Department of Geography, University of North Carolina at Chapel Hill Graduate School, Chapel Hill, North Carolina, USA.
  • Emch M; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
  • Pettifor AE; University of North Carolina Project-Malawi, Lilongwe, Malawi.
  • Juliano JJ; Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA.
  • Hoffman I; Department of Geography, University of North Carolina at Chapel Hill Graduate School, Chapel Hill, North Carolina, USA.
BMJ Glob Health ; 6(5)2021 05.
Article en En | MEDLINE | ID: mdl-33947708
INTRODUCTION: Malawi's malaria burden is primarily assessed via cross-sectional national household surveys. However, malaria is spatially and temporally heterogenous and no analyses have been performed at a subdistrict level throughout the course of a year. The WHO recommends mass distribution of long-lasting insecticide-treated bed nets (LLINs) every 3 years, but a national longitudinal evaluation has never been conducted in Malawi to determine LLIN effectiveness lifespans. METHODS: Using District Health Information Software 2 (DHIS2) health facility data, available from January 2018 to June 2020, we assessed malaria risk before and after a mass distribution campaign, stratifying by age group and comparing risk differences (RDs) by LLIN type or annual application of indoor residual spraying (IRS). RESULTS: 711 health facilities contributed 20 962 facility reports over 30 months. After national distribution of 10.7 million LLINs and IRS in limited settings, malaria risk decreased from 25.6 to 16.7 cases per 100 people from 2018 to 2019 high transmission seasons, and rebounded to 23.2 in 2020, resulting in significant RDs of -8.9 in 2019 and -2.4 in 2020 as compared with 2018. Piperonyl butoxide (PBO)-treated LLINs were more effective than pyrethroid-treated LLINs, with adjusted RDs of -2.3 (95% CI -2.7 to -1.9) and -1.5 (95% CI -2.0 to -1.0) comparing 2019 and 2020 high transmission seasons to 2018. Use of IRS sustained protection with adjusted RDs of -1.4 (95% CI -2.0 to -0.9) and -2.8% (95% CI -3.5 to -2.2) relative to pyrethroid-treated LLINs. Overall, 12 of 28 districts (42.9%) experienced increases in malaria risk in from 2018 to 2020. CONCLUSION: LLINs in Malawi have a limited effectiveness lifespan and IRS and PBO-treated LLINs perform better than pyrethroid-treated LLINs, perhaps due to net repurposing and insecticide-resistance. DHIS2 provides a compelling framework in which to examine localised malaria trends and evaluate ongoing interventions.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Mosquiteros Tratados con Insecticida / Insecticidas / Malaria Tipo de estudio: Observational_studies / Prevalence_studies / Risk_factors_studies Límite: Humans País/Región como asunto: Africa Idioma: En Revista: BMJ Glob Health Año: 2021 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Mosquiteros Tratados con Insecticida / Insecticidas / Malaria Tipo de estudio: Observational_studies / Prevalence_studies / Risk_factors_studies Límite: Humans País/Región como asunto: Africa Idioma: En Revista: BMJ Glob Health Año: 2021 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido