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Please use this identifier to cite or link to this item: http://repository.li.mahidol.ac.th/dspace/handle/123456789/16775
Title: Effect of artemether-lumefantrine policy and improved vector control on malaria burden in KwaZulu-Natal, South Africa
Authors: Karen I. Barnes
David N. Durrheim
Francesca Little
Amanda Jackson
Ushma Mehta
Elizabeth Allen
Sicelo S. Dlamini
Joyce Tsoka
Barry Bredenkamp
D. Jotham Mthembu
Nicholas J. White
Brian L. Sharp
University of Cape Town
Health Protection
South African Medical Research Council
Malaria Control Programme
Mahidol University
Churchill Hospital
Organisation Mondiale de la Sante
Keywords: Medicine
Issue Date: 1-Nov-2005
Citation: PLoS Medicine. Vol.2, No.11 (2005), 1123-1134
Abstract: Background: Between 1995 and 2000, KwaZulu-Natal province, South Africa, experienced a marked increase in Plasmodium falciparum malaria, fuelled by pyrethroid and sulfadoxine-pyrimethamine resistance. In response, vector control was strengthened and artemether-lumefantrine (AL) was deployed in the first Ministry of Health artemisinin-based combination treatment policy in Africa. In South Africa, effective vector and parasite control had historically ensured low-intensity malaria transmission. Malaria is diagnosed definitively and treatment is provided free of charge in reasonably accessible public-sector health-care facilities. Methods and Findings: We reviewed four years of malaria morbidity and mortality data at four sentinel health-care facilities within KwaZulu-Natal's malaria-endemic area. In the year following improved vector control and implementation of AL treatment, malaria-related admissions and deaths both declined by 89%, and outpatient visits decreased by 85% at the sentinel facilities. By 2003, malaria-related outpatient cases and admissions had fallen by 99%, and malaria-related deaths had decreased by 97%. There was a concomitant marked and sustained decline in notified malaria throughout the province. No serious adverse events were associated causally with AL treatment in an active sentinel pharmacovigilance survey. In a prospective study with 42 d follow up, AL cured 97/98 (99%) and prevented gametocyte developing in all patients. Consistent with the findings of focus group discussions, a household survey found self-reported adherence to the six-dose AL regimen was 96%. Conclusion: Together with concurrent strengthening of vector control measures, the antimalarial treatment policy change to AL in KwaZulu-Natal contributed to a marked and sustained decrease in malaria cases, admissions, and deaths, by greatly improving clinical and parasitological cure rates and reducing gametocyte carriage. © 2005 Barnes et al.
URI: https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=28444492707&origin=inward
http://repository.li.mahidol.ac.th/dspace/handle/123456789/16775
ISSN: 15491676
15491277
Appears in Collections:Scopus 2001-2005

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