The impact of artemisinin combination therapy and long-lasting insecticidal nets on forest malaria incidence in tribal villages of India, 2006-2011.

Abstract

INTRODUCTION:

New tools for malaria control, artemisinin combination therapy (ACT) and long-lasting insecticidal nets (LLINs) were recently introduced across India. We estimated the impact of universal coverage of ACT and ACT plus LLINs in a setting of hyperendemic, forest malaria transmission.

METHODS:

We reviewed data collected through active and passive case detection in a vaccine trial cohort of 2,204 tribal people residing in Sundargarh district, Odisha between 2006 and 2011. We compared measures of transmission at the village and individual level in 2006-2009 versus 2010-2011 after ACT (in all villages) and LLINs (in three villages) were implemented.

RESULTS:

During 2006-2009 malaria incidence per village ranged from 156-512 per 1000 persons per year and slide prevalence ranged from 28-53%. Routine indoor residual spray did not prevent seasonal peaks of malaria. Post-intervention impact in 2010-2011 was dramatic with ranges of 14-71 per 1000 persons per year and 6-16% respectively. When adjusted for village, ACT alone decreased the incidence of malaria by 83% (IRR 0.17, 95%CI: 0.10, 0.27) and areas using ACT and LLINs decreased the incidence of malaria by 86% (IRR 0.14, 95%CI: 0.05, 0.38). After intervention, the age of malaria cases, their parasite density, and proportion with fever at the time of screening increased.

CONCLUSIONS:

ACT, and LLINs along with ACT, effectively reduced malaria incidence in a closely monitored population living in a forest ecotype. It is unclear whether LLINs were impactful when prompt and quality antimalarial treatment was available. In spite of universal coverage, substantial malaria burden remained.

• Authors: Naman K Shah, Prajesh Tyagi, Surya K Sharma
• Journal: PloS one (PLoS One) Vol. 8 Issue 2 Pg. e56740 ( 2013) ISSN: 1932-6203 [Electronic] United States
• PMID: 23437229 (Publication Type: Journal Article)

Chemical References

• Antimalarials
• Artemisinins
• artemisinin

Topics

• Adolescent
• Antimalarials (administration & dosage)
• Artemisinins (administration & dosage)
• Child
• Child, Preschool
• Female
• Humans
• India
• Infant
• Infant, Newborn
• Insecticide-Treated Bednets
• Malaria (drug therapy, parasitology, transmission)
• Male
• Mosquito Control
• Plasmodium (drug effects, pathogenicity)
• Trees
• Young Adult