title: Changes in malaria indices between 1999 and 2007 in The Gambia: a retrospective analysis.
abstract: BACKGROUND
  Malaria is a major cause of morbidity and mortality in Africa. International effort and funding for control has been stepped up, with substantial increases from 2003 in the delivery of malaria interventions to pregnant women and children younger than 5 years in The Gambia. We investigated the changes in malaria indices in this country, and the causes and public-health significance of these changes.
  
  
  METHODS
  We undertook a retrospective analysis of original records to establish numbers and proportions of malaria inpatients, deaths, and blood-slide examinations at one hospital over 9 years (January, 1999-December, 2007), and at four health facilities in three different administrative regions over 7 years (January, 2001-December, 2007). We obtained additional data from single sites for haemoglobin concentrations in paediatric admissions and for age distribution of malaria admissions.
  
  
  RESULTS
  From 2003 to 2007, at four sites with complete slide examination records, the proportions of malaria-positive slides decreased by 82% (3397/10861 in 2003 to 337/6142 in 2007), 85% (137/1259 to 6/368), 73% (3664/16932 to 666/11333), and 50% (1206/3304 to 336/1853). At three sites with complete admission records, the proportions of malaria admissions fell by 74% (435/2530 to 69/1531), 69% (797/2824 to 89/1032), and 27% (2204/4056 to 496/1251). Proportions of deaths attributed to malaria in two hospitals decreased by 100% (seven of 115 in 2003 to none of 117 in 2007) and 90% (22/122 in 2003 to one of 58 in 2007). Since 2004, mean haemoglobin concentrations for all-cause admissions increased by 12 g/L (85 g/L in 2000-04 to 97 g/L in 2005-07), and mean age of paediatric malaria admissions increased from 3.9 years (95% CI 3.7-4.0) to 5.6 years (5.0-6.2).
  
  
  CONCLUSIONS
  A large proportion of the malaria burden has been alleviated in The Gambia. Our results encourage consideration of a policy to eliminate malaria as a public-health problem, while emphasising the importance of accurate and continuous surveillance.
authors.affiliation: Medical Research Council Laboratories, Fajara, Banjul, The Gambia.
authors.forename: Serign J
authors.initials: SJ
authors.lastname: Ceesay
authors.forename: Climent
authors.initials: C
authors.lastname: Casals-Pascual
authors.forename: Jamie
authors.initials: J
authors.lastname: Erskine
authors.forename: Samuel E
authors.initials: SE
authors.lastname: Anya
authors.forename: Nancy O
authors.initials: NO
authors.lastname: Duah
authors.forename: Anthony J C
authors.initials: AJ
authors.lastname: Fulford
authors.forename: Sanie S S
authors.initials: SS
authors.lastname: Sesay
authors.forename: Ismaela
authors.initials: I
authors.lastname: Abubakar
authors.forename: Samuel
authors.initials: S
authors.lastname: Dunyo
authors.forename: Omar
authors.initials: O
authors.lastname: Sey
authors.forename: Ayo
authors.initials: A
authors.lastname: Palmer
authors.forename: Malang
authors.initials: M
authors.lastname: Fofana
authors.forename: Tumani
authors.initials: T
authors.lastname: Corrah
authors.forename: Kalifa A
authors.initials: KA
authors.lastname: Bojang
authors.forename: Hilton C
authors.initials: HC
authors.lastname: Whittle
authors.forename: Brian M
authors.initials: BM
authors.lastname: Greenwood
authors.forename: David J
authors.initials: DJ
authors.lastname: Conway
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D000818:Animals; D000913:Antibodies, Protozoan / Q000097:blood; D002648:Child; D002675:Child, Preschool; D005260:Female; D005714:Gambia / Q000453:epidemiology; D006753:Hospital Records / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016778:Malaria, Falciparum / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control; D015337:Multicenter Studies as Topic; D010963:Plasmodium falciparum / Q000276:immunology; D011247:Pregnancy; D012189:Retrospective Studies; D012621:Seasons
chemical_list: D000913:Antibodies, Protozoan