Comparison of anaemia and parasitaemia as indicators of malaria control in household and EPI-health facility surveys in Malawi.
BACKGROUND
The World Health Organization has recommended that anaemia be used as an additional indicator to monitor malaria burden at the community level as malaria interventions are nationally scaled up. To date, there are no published evaluations of this recommendation.


METHODS
To evaluate this recommendation, a comparison of anaemia and parasitaemia among 6-30 month old children was made during two repeated cross-sectional household (HH) and health facility (HF) surveys in six districts across Malawi at baseline (2005) and in a follow-up survey (2008) after a scale up of malaria control interventions.


RESULTS
HH net ownership did not increase between the years (50.5% vs. 49.8%), but insecticide treated net (ITN) ownership increased modestly from 41.5% (95% CI: 37.2%-45.8%) in 2005 to 45.3% (95% CI: 42.6%-48.0%) in 2008. ITN use by children 6-30 months old, who were living in HH with at least one net, increased from 73.6% (95% CI:68.2%-79.1%) to 80.0% (95% CI:75.9%-84.1%) over the three-year period. This modest increase in ITN use was associated with a decrease in moderate to severe anaemia (Hb <8 g/dl) from 18.4% (95% CI:14.9%-21.8%) in 2005 to 15.4% (13.2%-17.7%) in 2008, while parasitaemia, measured as positive-slide microscopy, decreased from 18.9% (95% CI:14.7%-23.2%) to 16.9% (95% CI:13.8%-20.0%), a relative reduction of 16% and 11%, respectively. In HF surveys, anaemia prevalence decreased from 18.3% (95% CI: 14.9%-21.7%) to 15.4% (95% CI: 12.7%-18.2%), while parasitaemia decreased from 30.6% (95% CI: 25.7%-35.5%) to 13.2% (95% CI: 10.6%-15.8%), a relative reduction of 15% and 57%, respectively.


CONCLUSIONS
Increasing access to effective malaria prevention was associated with a reduced burden of malaria in young Malawian children. Anaemia measured at the HF level at time of routine vaccination may be a good surrogate indicator for its measurement at the HH level in evaluating national malaria control programmes.
Mathanga
Don P
DP
Malaria Alert Centre, College of Medicine, University of Malawi, P/Bag 360, Blantyre 3, Malawi. dmathang@mac.medcol.mw
Campbell
Carl H
CH
Vanden Eng
Jodi
J
Wolkon
Adam
A
Bronzan
Rachel N
RN
Malenga
Grace J
GJ
Ali
Doreen
D
Desai
Meghna
M
D000740:Anemia / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D000962:Antimalarials / Q000627:therapeutic use; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003625:Data Collection; D005191:Family Characteristics; D005260:Female; D019538:Health Care Surveys; D006268:Health Facilities / Q000706:statistics & numerical data; D006801:Humans; D017589:Immunization Programs; D007223:Infant; D057148:Insecticide-Treated Bednets; D016015:Logistic Models; D008288:Malaria / Q000175:diagnosis / Q000469:parasitology / Q000517:prevention & control*; D008295:Malawi / Q000453:epidemiology; D008297:Male; D009032:Mosquito Control / Q000379:methods; D018512:Parasitemia / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D015995:Prevalence; D011795:Surveys and Questionnaires
D000962:Antimalarials
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