Publication: Effect of artemether-lumefantrine policy and improved vector control on malaria burden in KwaZulu-Natal, South Africa
Issued Date
2005-11-01
Resource Type
ISSN
15491676
15491277
15491277
Other identifier(s)
2-s2.0-28444492707
Rights
Mahidol University
Rights Holder(s)
SCOPUS
Bibliographic Citation
PLoS Medicine. Vol.2, No.11 (2005), 1123-1134
Suggested Citation
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 Effect of artemether-lumefantrine policy and improved vector control on malaria burden in KwaZulu-Natal, South Africa. PLoS Medicine. Vol.2, No.11 (2005), 1123-1134. doi:10.1371/journal.pmed.0020330 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/16775
Research Projects
Organizational Units
Authors
Journal Issue
Thesis
Title
Effect of artemether-lumefantrine policy and improved vector control on malaria burden in KwaZulu-Natal, South Africa
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.