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Effectiveness of malaria control in Eritrea, 1996 to 2003. Patricia M Graves June 6, 2008 IRI. Eritrea. Eritrea – malaria prevalence survey 2002. Sintasath et al, 2005: 176 villages, 2,779 HH, 12,937 people. Overall prevalence 2.2%.

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eritrea malaria prevalence survey 2002
Eritrea – malaria prevalence survey 2002

Sintasath et al, 2005: 176 villages, 2,779 HH, 12,937 people. Overall prevalence 2.2%

1a eritrea malaria situation reported clinical malaria cases by age group eritrea 1996 to 2003
1a: Eritrea – malaria situationReported clinical malaria cases by age-group, Eritrea 1996 to 2003
routine surveillance data
Routine surveillance data
  • Can assist in:
    • Monitoring trends
    • Clarifying and measuring seasonality
    • Prioritizing areas for intervention
    • Defining and quantifying epidemics
    • Evaluating control measures
source of cases dataset
Source of cases dataset
  • 325 health facilities (1 to 9 per subzone)
  • Excluded:
    • National referral hospitals
    • Specialty clinics (ophthalmic and MCH)
    • Non-functioning facilities (no reports)
    • Private doctors
    • Worksite clinics
  • Remaining: 243 health facilities representing all subzones.
focus on reported outpatient clinical malaria cases
Focus on reported outpatient clinical malaria cases
  • Few facilities had diagnostics at start of period
  • Diagnostic capacity increased during study
  • Too few deaths and inpatients
  • Seasonal patterns clearly seen in clinical malaria cases
  • Inconsistency in lab forms for Pf/Pv.
slide15

Reported clinical malaria cases

Incidence / 1000 / yr, 1998

slide16

Reported clinical malaria cases

Incidence / 1000 / yr, 2000

slide17

Reported clinical malaria cases

Incidence / 1000 / yr, 2002

data sources used to analyze effectiveness of interventions
Data sources used to analyze effectiveness of interventions
  • Datasets for 96 months (1998 to 2003), 58 subzones (districts)
  • Outpatient clinical malaria cases by month from new NHMIS (restricted here from 325 to 242 health facilities).
  • Satellite-derived rainfall (CPC CMAP 0407) and NDVI (version e from USGS/ADDS), averaged over subzone.
  • Amounts of interventions applied (IRS, ITNs, larval control)
intervention data collected by subzone and month
Intervention data collected by subzone and month
  • Residual spraying (amount of chemical, people covered)
  • Number of impregnated nets issued and reimpregnated
  • Number of larval habitats eliminated
  • Chemical larviciding (number of sites, amount of chemical)
  • Treatments given by village health agents
analysis
Analysis
  • Outcome variable: number of clinical cases by subzone and month.
  • Cross-sectional multivariate time-series regression/ Poisson regression
  • First tested for ‘endogeneity’ (i.e. control being done in response to climate or increased case numbers) – no consistent pattern.
  • Independent variables expressed as ‘anomalies’ (deviations from subzone/calendar month means) to adjust for seasonality
  • Subzone fixed effect variables
  • Depreciation/cumulation of insecticides and nets
  • Climate variables as aggregated lags (Rain 2-3 months; NDVI 0-1 month.
positive relationships between climate variables and malaria cases anseba and gash barka
Positive relationships between climate variables and malariacases (Anseba and Gash Barka)

* p<0.05

*** p<0.001

eritrea analysis conclusions
Eritrea analysis conclusions
  • Reduction in cases in Eritrea from 1998 to 2003 was not solely due to climate shifts.
  • Both IRS (with DDT or malathion) in one zone, and ITNs in two zones, were independently associated with reduction in cases.
  • There was evidence of effectiveness of larval control in one zone.
  • Better monitoring of interventions, especially larval control, is needed.
  • Routine malaria surveillance data (despite known drawbacks) is useful for evaluating the effectiveness of control measures, as long as climate variation is taken into account.