title: Reductions in malaria and anaemia case and death burden at hospitals following scale-up of malaria control in Zanzibar, 1999-2008.
abstract: BACKGROUND
  In Zanzibar, the Ministry of Health and partners accelerated malaria control from September 2003 onwards. The impact of the scale-up of insecticide-treated nets (ITN), indoor-residual spraying (IRS) and artemisinin-combination therapy (ACT) combined on malaria burden was assessed at six out of seven in-patient health facilities.
  
  
  METHODS
  Numbers of outpatient and inpatient cases and deaths were compared between 2008 and the pre-intervention period 1999-2003. Reductions were estimated by segmented log-linear regression, adjusting the effect size for time trends during the pre-intervention period.
  
  
  RESULTS
  In 2008, for all age groups combined, malaria deaths had fallen by an estimated 90% (95% confidence interval 55-98%)(p < 0.025), malaria in-patient cases by 78% (48-90%), and parasitologically-confirmed malaria out-patient cases by 99.5% (92-99.9%). Anaemia in-patient cases decreased by 87% (57-96%); anaemia deaths and out-patient cases declined without reaching statistical significance due to small numbers. Reductions were similar for children under-five and older ages. Among under-fives, the proportion of all-cause deaths due to malaria fell from 46% in 1999-2003 to 12% in 2008 (p < 0.01) and that for anaemia from 26% to 4% (p < 0.01). Cases and deaths due to other causes fluctuated or increased over 1999-2008, without consistent difference in the trend before and after 2003.
  
  
  CONCLUSIONS
  Scaling-up effective malaria interventions reduced malaria-related burden at health facilities by over 75% within 5 years. In high-malaria settings, intensified malaria control can substantially contribute to reaching the Millennium Development Goal 4 target of reducing under-five mortality by two-thirds between 1990 and 2015.
authors.affiliation: World Health Organization, Global Malaria Programme, 20 Avenue Appia 1211 Geneva 27, Switzerland. aregawim@who.int
authors.forename: Maru W
authors.initials: MW
authors.lastname: Aregawi
authors.forename: Abdullah S
authors.initials: AS
authors.lastname: Ali
authors.forename: Abdul-wahiyd
authors.initials: AW
authors.lastname: Al-mafazy
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Molteni
authors.forename: Samson
authors.initials: S
authors.lastname: Katikiti
authors.forename: Marian
authors.initials: M
authors.lastname: Warsame
authors.forename: Ritha J A
authors.initials: RJ
authors.lastname: Njau
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Komatsu
authors.forename: Eline
authors.initials: E
authors.lastname: Korenromp
authors.forename: Mehran
authors.initials: M
authors.lastname: Hosseini
authors.forename: Daniel
authors.initials: D
authors.lastname: Low-Beer
authors.forename: Anders
authors.initials: A
authors.lastname: Bjorkman
authors.forename: Umberto
authors.initials: U
authors.lastname: D'Alessandro
authors.forename: Marc
authors.initials: M
authors.lastname: Coosemans
authors.forename: Mac
authors.initials: M
authors.lastname: Otten
mesh_terms: D000740:Anemia / Q000453:epidemiology* / Q000401:mortality; D000962:Antimalarials / Q000627:therapeutic use*; D037621:Artemisinins / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003140:Communicable Disease Control / Q000379:methods*; D004359:Drug Therapy, Combination / Q000379:methods; D006291:Health Policy; D006761:Hospitals; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007783:Lactones / Q000627:therapeutic use*; D008288:Malaria / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D009032:Mosquito Control / Q000379:methods*; D016019:Survival Analysis; D013636:Tanzania / Q000453:epidemiology
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D007783:Lactones; C075875:artemisin