Bhattarai A., Ali A.S., Kachur S.P., Mårtensson A., Abbas A.K., Khatib R., Al-mafazy A.-W., Ramsan M., Rotllant G., Gerstenmaier J.F., Molteni F., Abdulla S., Montgomery S.M., Kaneko A., Björkman A.
Infectious Diseases Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Zanzibar Malaria Control Programme, Zanzibar, Tanzania; Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, United States; Ifakara Health Research and Development Centre, Dar-es-Salaam, Tanzania; Emergency Medicine Unit, Department of Medicine, Kullbergska Hospital, Katrineholm, Sweden; International Development Group, Research Triangle Institute, Zanzibar, Tanzania; Department of Accident and Emergency, Southern General Hospital, Glasgow, United Kingdom; Italian Co-operation, Dar-es-Salaam, Tanzania; Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Clinical Research Centre, Örebro University Hospital, Örebro, Sweden
Bhattarai, A., Infectious Diseases Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Ali, A.S., Zanzibar Malaria Control Programme, Zanzibar, Tanzania; Kachur, S.P., Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, United States, Ifakara Health Research and Development Centre, Dar-es-Salaam, Tanzania; Mårtensson, A., Infectious Diseases Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden, Emergency Medicine Unit, Department of Medicine, Kullbergska Hospital, Katrineholm, Sweden; Abbas, A.K., Zanzibar Malaria Control Programme, Zanzibar, Tanzania; Khatib, R., Ifakara Health Research and Development Centre, Dar-es-Salaam, Tanzania; Al-mafazy, A.-W., Zanzibar Malaria Control Programme, Zanzibar, Tanzania; Ramsan, M., International Development Group, Research Triangle Institute, Zanzibar, Tanzania; Rotllant, G., Infectious Diseases Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Gerstenmaier, J.F., Department of Accident and Emergency, Southern General Hospital, Glasgow, United Kingdom; Molteni, F., Italian Co-operation, Dar-es-Salaam, Tanzania; Abdulla, S., Ifakara Health Research and Development Centre, Dar-es-Salaam, Tanzania; Montgomery, S.M., Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden, Clinical Research Centre, Örebro University Hospital, Örebro, Sweden; Kaneko, A., Infectious Diseases Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Björkman, A., Infectious Diseases Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
Background: The Roll Back Malaria strategy recommends a combination of interventions for malaria control. Zanzibar implemented artemisinin-based combination therapy (ACT) for uncomplicated malaria in late 2003 and long-lasting insecticidal nets (LLINs) from early 2006. ACT is provided free of charge to all malaria patients, while LLINs are distributed free to children under age 5 y ("under five") and pregnant women. We investigated temporal trends in Plasmodium falciparum prevalence and malaria-related health parameters following the implementation of these two malaria control interventions in Zanzibar. Methods and Findings: Cross-sectional clinical and parasitological surveys in children under the age of 14 y were conducted in North A District in May 2003, 2005, and 2006. Survey data were analyzed in a logistic regression model and adjusted for complex sampling design and potential confounders. Records from all 13 public health facilities in North A District were analyzed for malaria-related outpatient visits and admissions. Mortality and demographic data were obtained from District Commissioner's Office. P. falciparum prevalence decreased in children under five between 2003 and 2006; using 2003 as the reference year, odds ratios (ORs) and 95% confidence intervals (CIs) were, for 2005, 0.55 (0.28-1.08), and for 2006, 0.03 (0.00-0.27); p for trend < 0.001. Between 2002 and 2005 crude under-five, infant (under age 1 y), and child (aged 1-4 y) mortality decreased by 52%, 33%, and 71%, respectively. Similarly, malaria-related admissions, blood transfusions, and malaria-attributed mortality decreased significantly by 77%, 67% and 75%, respectively, between 2002 and 2005 in children under five. Climatic conditions favorable for malaria transmission persisted throughout the observational period. Conclusions: Following deployment of ACT in Zanzibar 2003, malaria-associated morbidity and mortality decreased dramatically within two years. Additional distribution of LLINs in early 2006 resulted in a 10-fold reduction of malaria parasite prevalence. The results indicate that the Millennium Development Goals of reducing mortality in children under five and alleviating the burden of malaria are achievable in tropical Africa with high coverage of combined malaria control interventions.