Changing malaria fever test positivity among paediatric admissions to Tororo district hospital, Uganda 2012–2019
Abstract Background The World Health Organization (WHO) promotes long-lasting insecticidal nets (LLIN) and indoor residual house-spraying (IRS) for malaria control in endemic countries. However, long-term impact data of vector control interventions is rarely measured empirically. Methods Surveillanc...
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| Format: | Article |
| Language: | English |
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BMC
2020-11-01
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| Series: | Malaria Journal |
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| Online Access: | http://link.springer.com/article/10.1186/s12936-020-03490-4 |
| _version_ | 1818116512179814400 |
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| author | Arthur Mpimbaza Asadu Sserwanga Damian Rutazaana James Kapisi Richard Walemwa Laurissa Suiyanka David Kyalo Moses Kamya Jimmy Opigo Robert W. Snow |
| author_facet | Arthur Mpimbaza Asadu Sserwanga Damian Rutazaana James Kapisi Richard Walemwa Laurissa Suiyanka David Kyalo Moses Kamya Jimmy Opigo Robert W. Snow |
| author_sort | Arthur Mpimbaza |
| collection | DOAJ |
| description | Abstract Background The World Health Organization (WHO) promotes long-lasting insecticidal nets (LLIN) and indoor residual house-spraying (IRS) for malaria control in endemic countries. However, long-term impact data of vector control interventions is rarely measured empirically. Methods Surveillance data was collected from paediatric admissions at Tororo district hospital for the period January 2012 to December 2019, during which LLIN and IRS campaigns were implemented in the district. Malaria test positivity rate (TPR) among febrile admissions aged 1 month to 14 years was aggregated at baseline and three intervention periods (first LLIN campaign; Bendiocarb IRS; and Actellic IRS + second LLIN campaign) and compared using before-and-after analysis. Interrupted time-series analysis (ITSA) was used to determine the effect of IRS (Bendiocarb + Actellic) with the second LLIN campaign on monthly TPR compared to the combined baseline and first LLIN campaign periods controlling for age, rainfall, type of malaria test performed. The mean and median ages were examined between intervention intervals and as trend since January 2012. Results Among 28,049 febrile admissions between January 2012 and December 2019, TPR decreased from 60% at baseline (January 2012–October 2013) to 31% during the final period of Actellic IRS and LLIN (June 2016–December 2019). Comparing intervention intervals to the baseline TPR (60.3%), TPR was higher during the first LLIN period (67.3%, difference 7.0%; 95% CI 5.2%, 8.8%, p < 0.001), and lower during the Bendiocarb IRS (43.5%, difference − 16.8%; 95% CI − 18.7%, − 14.9%) and Actellic IRS (31.3%, difference − 29.0%; 95% CI − 30.3%, − 27.6%, p < 0.001) periods. ITSA confirmed a significant decrease in the level and trend of TPR during the IRS (Bendicarb + Actellic) with the second LLIN period compared to the pre-IRS (baseline + first LLIN) period. The age of children with positive test results significantly increased with time from a mean of 24 months at baseline to 39 months during the final IRS and LLIN period. Conclusion IRS can have a dramatic impact on hospital paediatric admissions harbouring malaria infection. The sustained expansion of effective vector control leads to an increase in the age of malaria positive febrile paediatric admissions. However, despite large reductions, malaria test-positive admissions continued to be concentrated in children aged under five years. Despite high coverage of IRS and LLIN, these vector control measures failed to interrupt transmission in Tororo district. Using simple, cost-effective hospital surveillance, it is possible to monitor the public health impacts of IRS in combination with LLIN. |
| first_indexed | 2024-12-11T04:23:41Z |
| format | Article |
| id | doaj.art-824fc2e254514ea3805586a261fde263 |
| institution | Directory Open Access Journal |
| issn | 1475-2875 |
| language | English |
| last_indexed | 2024-12-11T04:23:41Z |
| publishDate | 2020-11-01 |
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| series | Malaria Journal |
| spelling | doaj.art-824fc2e254514ea3805586a261fde2632022-12-22T01:21:02ZengBMCMalaria Journal1475-28752020-11-0119111110.1186/s12936-020-03490-4Changing malaria fever test positivity among paediatric admissions to Tororo district hospital, Uganda 2012–2019Arthur Mpimbaza0Asadu Sserwanga1Damian Rutazaana2James Kapisi3Richard Walemwa4Laurissa Suiyanka5David Kyalo6Moses Kamya7Jimmy Opigo8Robert W. Snow9Child Health and Development Centre, Makerere University, College of Health SciencesInfectious Diseases Research CollaborationNational Malaria Control Division, Ministry of HealthInfectious Diseases Research CollaborationDepartment of Prevention, Care and Treatment, Infectious Diseases InstitutePopulation Health Unit, Kenya Medical Research Institute/Wellcome Trust Research ProgrammePopulation Health Unit, Kenya Medical Research Institute/Wellcome Trust Research ProgrammeInfectious Diseases Research CollaborationNational Malaria Control Division, Ministry of HealthPopulation Health Unit, Kenya Medical Research Institute/Wellcome Trust Research ProgrammeAbstract Background The World Health Organization (WHO) promotes long-lasting insecticidal nets (LLIN) and indoor residual house-spraying (IRS) for malaria control in endemic countries. However, long-term impact data of vector control interventions is rarely measured empirically. Methods Surveillance data was collected from paediatric admissions at Tororo district hospital for the period January 2012 to December 2019, during which LLIN and IRS campaigns were implemented in the district. Malaria test positivity rate (TPR) among febrile admissions aged 1 month to 14 years was aggregated at baseline and three intervention periods (first LLIN campaign; Bendiocarb IRS; and Actellic IRS + second LLIN campaign) and compared using before-and-after analysis. Interrupted time-series analysis (ITSA) was used to determine the effect of IRS (Bendiocarb + Actellic) with the second LLIN campaign on monthly TPR compared to the combined baseline and first LLIN campaign periods controlling for age, rainfall, type of malaria test performed. The mean and median ages were examined between intervention intervals and as trend since January 2012. Results Among 28,049 febrile admissions between January 2012 and December 2019, TPR decreased from 60% at baseline (January 2012–October 2013) to 31% during the final period of Actellic IRS and LLIN (June 2016–December 2019). Comparing intervention intervals to the baseline TPR (60.3%), TPR was higher during the first LLIN period (67.3%, difference 7.0%; 95% CI 5.2%, 8.8%, p < 0.001), and lower during the Bendiocarb IRS (43.5%, difference − 16.8%; 95% CI − 18.7%, − 14.9%) and Actellic IRS (31.3%, difference − 29.0%; 95% CI − 30.3%, − 27.6%, p < 0.001) periods. ITSA confirmed a significant decrease in the level and trend of TPR during the IRS (Bendicarb + Actellic) with the second LLIN period compared to the pre-IRS (baseline + first LLIN) period. The age of children with positive test results significantly increased with time from a mean of 24 months at baseline to 39 months during the final IRS and LLIN period. Conclusion IRS can have a dramatic impact on hospital paediatric admissions harbouring malaria infection. The sustained expansion of effective vector control leads to an increase in the age of malaria positive febrile paediatric admissions. However, despite large reductions, malaria test-positive admissions continued to be concentrated in children aged under five years. Despite high coverage of IRS and LLIN, these vector control measures failed to interrupt transmission in Tororo district. Using simple, cost-effective hospital surveillance, it is possible to monitor the public health impacts of IRS in combination with LLIN.http://link.springer.com/article/10.1186/s12936-020-03490-4ChangingTestPositivityPaediatric admissionsUganda |
| spellingShingle | Arthur Mpimbaza Asadu Sserwanga Damian Rutazaana James Kapisi Richard Walemwa Laurissa Suiyanka David Kyalo Moses Kamya Jimmy Opigo Robert W. Snow Changing malaria fever test positivity among paediatric admissions to Tororo district hospital, Uganda 2012–2019 Malaria Journal Changing Test Positivity Paediatric admissions Uganda |
| title | Changing malaria fever test positivity among paediatric admissions to Tororo district hospital, Uganda 2012–2019 |
| title_full | Changing malaria fever test positivity among paediatric admissions to Tororo district hospital, Uganda 2012–2019 |
| title_fullStr | Changing malaria fever test positivity among paediatric admissions to Tororo district hospital, Uganda 2012–2019 |
| title_full_unstemmed | Changing malaria fever test positivity among paediatric admissions to Tororo district hospital, Uganda 2012–2019 |
| title_short | Changing malaria fever test positivity among paediatric admissions to Tororo district hospital, Uganda 2012–2019 |
| title_sort | changing malaria fever test positivity among paediatric admissions to tororo district hospital uganda 2012 2019 |
| topic | Changing Test Positivity Paediatric admissions Uganda |
| url | http://link.springer.com/article/10.1186/s12936-020-03490-4 |
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