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Open Access Highly Accessed Research

Changes in the burden of malaria following scale up of malaria control interventions in Mutasa District, Zimbabwe

Sungano Mharakurwa12, Susan L Mutambu3, Joseph Mberikunashe4, Philip E Thuma12, William J Moss1, Peter R Mason56* and for the Southern Africa ICEMR Team

Author Affiliations

1 Johns Hopkins Malaria Research Institute, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205, USA

2 Macha Research Trust, Namwala Road, P.O. Box 630166, Choma, Zambia

3 National Institute of Health Research, P.O. Box 573 Harare, Zimbabwe

4 National Malaria Control Programme, Ministry of Health and Child Welfare, Harare, Zimbabwe

5 Biomedical Research and Training Institute, Nicoz Diamond House, Samora Machel Ave, P.O. Box CY1753, Harare, Zimbabwe

6 College of Health Sciences University of Zimbabwe, P.O. box A 178, Avondale Harare, Zimbabwe

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Malaria Journal 2013, 12:223  doi:10.1186/1475-2875-12-223

Published: 1 July 2013

Abstract

Background

To better understand trends in the burden of malaria and their temporal relationship to control activities, a survey was conducted to assess reported cases of malaria and malaria control activities in Mutasa District, Zimbabwe.

Methods

Data on reported malaria cases were abstracted from available records at all three district hospitals, three rural hospitals and 25 rural health clinics in Mutasa District from 2003 to 2011.

Results

Malaria control interventions were scaled up through the support of the Roll Back Malaria Partnership, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and The President’s Malaria Initiative. The recommended first-line treatment regimen changed from chloroquine or a combination of chloroquine plus sulphadoxine/pyrimethamine to artemisinin-based combination therapy, the latter adopted by 70%, 95% and 100% of health clinics by 2008, 2009 and 2010, respectively. Diagnostic capacity improved, with rapid diagnostic tests (RDTs) available in all health clinics by 2008. Vector control consisted of indoor residual spraying and distribution of long-lasting insecticidal nets. The number of reported malaria cases initially increased from levels in 2003 to a peak in 2008 but then declined 39% from 2008 to 2010. The proportion of suspected cases of malaria in older children and adults remained high, ranging from 75% to 80%. From 2008 to 2010, the number of RDT positive cases of malaria decreased 35% but the decrease was greater for children younger than five years of age (60%) compared to older children and adults (26%).

Conclusions

The burden of malaria in Mutasa District decreased following the scale up of malaria control interventions. However, the persistent high number of cases in older children and adults highlights the need for strategies to identify locally effective control measures that target all age groups.

Keywords:
Malaria; Epidemiology; Transmission; Control; Prevalence; Zimbabwe