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

TLDR

Malaria‑endemic African countries are rapidly scaling up prevention and treatment. The study estimates the impact of nationwide LLIN and ACT roll‑out by analyzing health‑facility time trends in selected districts of Ethiopia and Rwanda. The authors sampled health facilities in Ethiopia and Rwanda and compared pre‑ and post‑LLIN/ACT implementation inpatient malaria case and death rates in children under five. Inpatient malaria cases and deaths in children under five fell 55–73% in Rwanda and Ethiopia, while non‑malaria outcomes remained stable, indicating that nationwide LLIN and ACT roll‑out substantially reduced malaria burden and that clinic data can monitor this impact.

Abstract

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.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.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.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.