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

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.

Figure 1

Location of hospitals and health centers that were selected for data collection and had complete data for 2001–2007, November 2007, Ethiopia.

Figure 2

Location of hospitals and health centers that were selected for data collection and had complete data, December 2007, Rwanda.

Figure 3

Malaria and non-malaria in- and out-patient cases, children < 5 years old, January to October 2001–2007, Rwanda. LLIN = long-lasting insecticidal nets, ACT = artemisinin-based combination therapy medicines.

Figure 4

Malaria and non-malaria in- and out-patient cases, children < 5 years old, January to October 2001–2007, Ethiopia. LLIN = long-lasting insecticidal nets, ACT = artemisinin-based combination therapy medicines.

Figure 5

In-patient malaria cases, out-patient laboratory-confirmed cases, and in-patient non-malaria cases, by month, all ages, January 2001 to October 2007, Rwanda. LLIN = long-lasting insecticidal nets, ACT = artemisinin-based combination therapy medicines.