Repeated mosquito net distributions, improved treatment, and trends in malaria cases in sentinel health facilities in Papua New Guinea.

Autor: Rodriguez-Rodriguez D; Swiss Tropical and Public Health Institute, Basel, Switzerland.; University of Basel, Basel, Switzerland.; Papua New Guinea Institute of Medical Research, Goroka and Madang, Papua New Guinea., Maraga S; Papua New Guinea Institute of Medical Research, Goroka and Madang, Papua New Guinea., Lorry L; Papua New Guinea Institute of Medical Research, Goroka and Madang, Papua New Guinea., Robinson LJ; Papua New Guinea Institute of Medical Research, Goroka and Madang, Papua New Guinea.; Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia.; Burnet Institute, Melbourne, Australia., Siba PM; Papua New Guinea Institute of Medical Research, Goroka and Madang, Papua New Guinea., Mueller I; Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia.; Institut Pasteur, Paris, France., Pulford J; Liverpool School of Tropical Medicine, Liverpool, UK., Ross A; Swiss Tropical and Public Health Institute, Basel, Switzerland.; University of Basel, Basel, Switzerland., Hetzel MW; Swiss Tropical and Public Health Institute, Basel, Switzerland. manuel.hetzel@swisstph.ch.; University of Basel, Basel, Switzerland. manuel.hetzel@swisstph.ch.
Jazyk: angličtina
Zdroj: Malaria journal [Malar J] 2019 Nov 12; Vol. 18 (1), pp. 364. Date of Electronic Publication: 2019 Nov 12.
DOI: 10.1186/s12936-019-2993-6
Abstrakt: Background: Long-lasting insecticidal nets (LLIN), improved diagnosis and artemisinin-based combination therapy (ACT) have reduced malaria prevalence in Papua New Guinea since 2008. Yet, national incidence trends are inconclusive due to confounding effects of the scale-up of rapid diagnostic tests, and inconsistencies in routine reporting.
Methods: Malaria trends and their association with LLIN and ACT roll-out between 2010 and 2014 in seven sentinel health facilities were analysed. The analysis included 35,329 fever patients. Intervention effects were estimated using regression models.
Results: Malaria incidence initially ranged from 20 to 115/1000 population; subsequent trends varied by site. Overall, LLIN distributions had a cumulative effect, reducing the number of malaria cases with each round (incidence rate ratio ranging from 0.12 to 0.53 in five sites). No significant reduction was associated with ACT introduction. Plasmodium falciparum remained the dominant parasite in all sentinel health facilities. Resurgence occurred in one site in which a shift to early and outdoor biting of anophelines had previously been documented.
Conclusions: LLINs, but not ACT, were associated with reductions of malaria cases in a range of settings, but sustainability of the gains appear to depend on local factors. Malaria programmes covering diverse transmission settings such as Papua New Guinea must consider local heterogeneity when choosing interventions and ensure continuous monitoring of trends.
Databáze: MEDLINE
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