Thursday, 3rd of September 2009 |
CSU 51/2009: MARKED INCREASE IN CHILD SURVIVAL AFTER FOUR YEARS OF INTENSIVE MALARIA CONTROL
In heavily endemic countries, malaria evaluation often looks at U5MR as
well as declines in malaria-specific mortality. In Bioko, Equatorial
Guinea, ‘Under-5 mortality fell from 152 per 1,000 births (95% CI =
122–186) to 55 per 1,000 (95% CI = 38–77; hazard ratio = 0.34 [95% CI =
0.23–0.49]).’
Good reading.
Bob Davis
Am. J. Trop. Med. Hyg., 80(6), 2009, pp. 882-888
Copyright © 2009 by The American Society of Tropical Medicine and Hygiene
Marked Increase in Child Survival after Four Years of Intensive Malaria
Control
Immo Kleinschmidt*, Christopher Schwabe, Luis Benavente, Miguel Torrez,
Frances C. Ridl, Jose Luis Segura, Paul Ehmer, AND Gloria Nseng Nchama
London School of Hygiene and Tropical Medicine, London, United Kingdom;
Medical Care Development International, Silver Spring, Maryland; Malaria
Research Programme, South African Medical Research Council, Durban, South
Africa; Ministry of Health and Social Welfare, Malabo, Equatorial Guinea
In malaria-endemic countries in Africa, a large proportion of child deaths
are directly or indirectly attributable to infection with Plasmodium
falciparum. Four years after high coverage, multiple malaria control
interventions were introduced on Bioko Island, Equatorial Guinea, changes
in infection with malarial parasites, anemia, and fever history in children
were estimated and assessed in relation to changes in all-cause under-5
mortality. There were reductions in prevalence of infection (odds ratio
[OR] = 0.31, 95% confidence interval [CI] = 0.2–0.46), anemia (OR = 0.11,
95% CI = 0.07–0.18), and reported fevers (OR = 0.41, 95% CI = 0.22–0.76) in
children.
Under-5 mortality fell from 152 per 1,000 births (95% CI = 122–186) to 55
per 1,000 (95% CI = 38–77; hazard ratio = 0.34 [95% CI =
0.23–0.49]).Effective malaria control measures can dramatically increase
child survival and play a key role in achieving millennium development
goals.
Received January 29, 2009. Accepted for publication March 6, 2009.
Acknowledgments: The authors thank the late Brian Sharp for his role in the
design of the study and the interpretation of the entomology results; Adel
Chaouch for invaluable support in the execution of the intervention; and
Giovanna Baltazar, Manuel Yataco, and David Jituboh for contributions in
ensuring the quality of the survey data.
* Address correspondence to Immo Kleinschmidt, London School of Hygiene and
Tropical Medicine, Keppel Street, London WC1E 7HT, UK. E-mail:
Immo.Kleinschmidt@lshtm.ac.uk
Authors’ addresses: Immo Kleinschmidt, London School of Hygiene and
Tropical Medicine, Keppel Street, London WC1E 7HT, UK, Tel:
44-0-20-7927-2103, E-mail: Immo.Kleinschmidt@lshtm.ac.uk . Christopher
Schwabe, Medical Care Development International, 8401 Colesville Rd., Suite
425, Silver Spring, MD 20910, Tel: 301-562-1920, Fax: 301-562-1921, E-mail:
cschwabe@mcd.org . Luis Benavente, Medical Care Development International,
8401 Colesville Rd., Suite 425, Silver Spring, MD 20910, Tel: 301-562-1920,
Fax: 301-562-1921, E-mail: lbenavente@mcd.org . Miguel Torrez, Medical Care
Development International, 8401 Colesville Rd., Suite 425, Silver Spring,
MD 20910, Tel: 301-562-1920, Fax: 301-562-1921, E-mail: mitorrez@gmail.com
. Frances C. Ridl, Medical Research Council, 491 Ridge Rd., Overport,
Durban 4091, South Africa, Tel: 27-31-203-4700, Fax: 27-31-203-4704,
E-mail: frances.ridl@mrc.ac.za . Jose Luis Segura, Medical Care Development
International, 8401 Colesville Rd., Suite 425, Silver Spring, MD 20910,
Tel: 301-562-1920, Fax: 301-562-1921, E-mail: lsegura1212@gmail.com . Paul
Ehmer, Medical Care Development International, 8401 Colesville Rd., Suite
425, Silver Spring, MD 20910, Tel: 301-562-1920, Fax: 301-562-1921, E-mail:
pehmer@mcd.org . Gloria Nseng Nchama, Ministry of Health and Social
Welfare, Malabo, Equatorial Guinea, E-mail: glorianseng@yahoo.es .
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