Initial evidence of reduction of malaria cases and deaths in Rwanda and Ethiopia due to rapid scale-up of malaria prevention and treatment

doi:10.1186/1475-2875-8-14

Malaria Journal

Volume 8

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Otten M
Aregawi M
Were W
Karema C
Medin A
Bekele W
Jima D
Gausi K
Komatsu R
Korenromp E
Low-Beer D
Grabowsky M

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Otten M
Aregawi M
Were W
Karema C
Medin A
Bekele W
Jima D
Gausi K
Komatsu R
Korenromp E
Low-Beer D
Grabowsky M
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Research

Initial evidence of reduction of malaria cases and deaths in Rwanda and Ethiopia due to rapid scale-up of malaria prevention and treatment

Mac Otten¹ , Maru Aregawi¹ , Wilson Were¹ , Corine Karema² , Ambachew Medin¹ , Worku Bekele³ , Daddi Jima⁴ , Khoti Gausi⁵ , Ryuichi Komatsu⁶ , Eline Korenromp⁶ , Daniel Low-Beer⁶ and Mark Grabowsky⁶

¹World Health Organization, Global Malaria Program, Geneva, Switzerland

²Ministry of Health, Kigale, Rwanda

³World Health Organization, Addis Ababa, Ethiopia

⁴Ministry of Health, Addis Ababa, Ethiopia

⁵World Health Organization, Harare, Zimbabwe

⁶Global Fund for AIDS, TB and Malaria, Geneva, Switzerland

author email corresponding author email

Malaria Journal 2009, 8:14doi:10.1186/1475-2875-8-14


Published:	14 January 2009

Abstract

Background

An increasing number of malaria-endemic African countries are rapidly scaling up malaria prevention and treatment. To have an initial estimate of the impact of these efforts, time trends in health facility records were evaluated in selected districts in Ethiopia and Rwanda, where long-lasting insecticidal nets (LLIN) and artemisinin-based combination therapy (ACT) had been distributed nationwide by 2007.

Methods

In Ethiopia, a stratified convenience sample covered four major regions where (moderately) endemic malaria occurs. In Rwanda, two districts were sampled in all five provinces, with one rural health centre and one rural hospital selected in each district. The main impact indicator was percentage change in number of in-patient malaria cases and deaths in children < 5 years old prior to (2001–2005/6) and after (2007) nationwide implementation of LLIN and ACT.

Results

In-patient malaria cases and deaths in children < 5 years old in Rwanda fell by 55% and 67%, respectively, and in Ethiopia by 73% and 62%. Over this same time period, non-malaria cases and deaths generally remained stable or increased.

Conclusion

Initial evidence indicated that the combination of mass distribution of LLIN to all children < 5 years or all households and nationwide distribution of ACT in the public sector was associated with substantial declines of in-patient malaria cases and deaths in Rwanda and Ethiopia. Clinic-based data was a useful tool for local monitoring of the impact of malaria programmes.