title: A steep decline of malaria morbidity and mortality trends in Eritrea between 2000 and 2004: the effect of combination of control methods.
abstract: BACKGROUND
  Malaria is a huge public health problem in Africa that is responsible for more than one million deaths annually. In line with the Roll Back Malaria initiative and the Abuja Declaration, Eritrea and other African countries have intensified their fight against malaria. This study examines the impact of Eritrea's Roll Back Malaria Programme: 2000-2004 and the effects and possible interactions between the public health interventions in use.
  
  
  METHODS
  This study employed cross-sectional survey to collect data from households, community and health facilities on coverage and usage of Insecticide-Treated Nets (ITNs), Indoor Residual Spraying (IRS), larvicidal activities and malaria case management. Comparative data was obtained from a similar survey carried out in 2001. Data from the Health Management Information System (HMIS) and reports of the annual assessments by the National Malaria Control Programme was used to assess impact. Time series model (ARIMA) was used to assess association.
  
  
  RESULTS
  In the period 2000-2004, approximately 874,000 ITNs were distributed and 13,109 health workers and community health agents were trained on malaria case management. In 2004, approximately 81% households owned at least one net, of which 73% were ITNs and 58.6% of children 0-5 years slept under a net. The proportion of malaria cases managed by community health agents rose from 50% in 1999 to 78% in 2004. IRS coverage increased with the combined amount of DDT and Malathion used rising from 6,444 kg, in 2000 to 43,491 kg, in 2004, increasing the population protected from 117,017 to 259,420. Drug resistance necessitated regimen change to chloroquine plus sulfadoxine-pyrimethamine. During the period, there was a steep decline in malaria morbidity and case fatality by 84% and 40% respectively. Malaria morbidity was strongly correlated to the numbers of ITNs distributed (beta = -0.125, p < 0.005) and the amount (kg) of DDT and Malathion used for IRS (beta = -2.352, p < 0.05). The correlation between malaria case fatality and ITNs, IRS, population protected and annual rainfall was not statistically significant.
  
  
  CONCLUSIONS
  Eritrea has within 5 years attained key Roll Back Malaria targets. ITNs and IRS contributed most to reducing malaria morbidity.
authors.affiliation: Orotta School of Medicine, P,O, Box 10549, Asmara, Eritrea. mnyarango@yahoo.com
authors.forename: Peter M
authors.initials: PM
authors.lastname: Nyarango
authors.forename: Tewolde
authors.initials: T
authors.lastname: Gebremeskel
authors.forename: Goitom
authors.initials: G
authors.lastname: Mebrahtu
authors.forename: Jacob
authors.initials: J
authors.lastname: Mufunda
authors.forename: Usman
authors.initials: U
authors.lastname: Abdulmumini
authors.forename: Andom
authors.initials: A
authors.lastname: Ogbamariam
authors.forename: Andrew
authors.initials: A
authors.lastname: Kosia
authors.forename: Andemariam
authors.initials: A
authors.lastname: Gebremichael
authors.forename: Disanayike
authors.initials: D
authors.lastname: Gunawardena
authors.forename: Yohannes
authors.initials: Y
authors.lastname: Ghebrat
authors.forename: Yahannes
authors.initials: Y
authors.lastname: Okbaldet
mesh_terms: D000328:Adult; D000962:Antimalarials / Q000494:pharmacology*; D001512:Bedding and Linens; D002648:Child; D002738:Chloroquine / Q000627:therapeutic use; D003634:DDT / Q000627:therapeutic use; D004338:Drug Combinations; D004351:Drug Resistance; D019017:Eritrea / Q000453:epidemiology; D005260:Female; D006801:Humans; D007306:Insecticides / Q000627:therapeutic use*; D008288:Malaria / Q000401:mortality* / Q000517:prevention & control*; D008294:Malathion / Q000627:therapeutic use; D008297:Male; D009032:Mosquito Control / Q000379:methods*; D009313:National Health Programs; D011634:Public Health; D011739:Pyrimethamine / Q000627:therapeutic use; D013413:Sulfadoxine / Q000627:therapeutic use; D013997:Time Factors
chemical_list: D000962:Antimalarials; D004338:Drug Combinations; D007306:Insecticides; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D002738:Chloroquine; D003634:DDT; D008294:Malathion; D011739:Pyrimethamine