title: Morbidity and mortality due to malaria in Est Mono district, Togo, from 2005 to 2010: a times series analysis.
abstract: BACKGROUND
  In 2004, Togo adopted a regional strategy for malaria control that made use of insecticide-treated nets (ITNs), followed by the use of rapid diagnostic tests (RDTs), artemisinin-based combination therapy (ACT). Community health workers (CHWs) became involved in 2007. In 2010, the impact of the implementation of these new malaria control strategies had not yet been evaluated. This study sought to assess the trends of malaria incidence and mortality due to malaria in Est Mono district from 2005 to 2010.
  
  
  METHODS
  Secondary data on confirmed and suspected malaria cases reported by health facilities from 2005 to 2010 were obtained from the district health information system. Rainfall and temperature data were provided by the national Department of Meteorology. Chi square test or independent student's t-test were used to compare trends of variables at a 95% confidence interval. An interrupted time series analysis was performed to assess the effect of meteorological factors and the use of ACT and CHWs on morbidity and mortality due to malaria.
  
  
  RESULTS
  From January 2005 to December 2010, 114,654 malaria cases (annual mean 19,109 ± 6,622) were reported with an increase of all malaria cases from 10,299 in 2005 to 26,678 cases in 2010 (p<0.001). Of the 114,654 malaria cases 52,539 (45.8%) were confirmed cases. The prevalence of confirmed malaria cases increased from 23.1 per 1,000 in 2005 to 257.5 per 1,000 population in 2010 (p <0.001). The mortality rate decreased from 7.2 per 10,000 in 2005 to 3.6 per 10,000 in 2010 (p <0.001), with a significant reduction of 43.9% of annual number of death due to malaria. Rainfall (β-coefficient = 1.6; p = 0.05) and number of CHWs trained (β-coefficient = 6.8; p = 0.002) were found to be positively correlated with malaria prevalence.
  
  
  CONCLUSIONS
  This study showed an increase of malaria prevalence despite the implementation of the use of ACT and CHW strategies. Multicentre data analysis over longer periods should be carried out in similar settings to assess the impact of malaria control strategies on the burden of the disease. Integrated malaria vector control management should be implemented in Togo to reduce malaria transmission.
authors.affiliation: Division de l'Epidémiologie, Ministère de la Santé du Togo, BP: 1396, Lomé, Togo. mlandoh@yahoo.fr
authors.forename: Essoya D
authors.initials: ED
authors.lastname: Landoh
authors.forename: Potougnima
authors.initials: P
authors.lastname: Tchamdja
authors.forename: Bayaki
authors.initials: B
authors.lastname: Saka
authors.forename: Khin S
authors.initials: KS
authors.lastname: Tint
authors.forename: Sheba N
authors.initials: SN
authors.lastname: Gitta
authors.forename: Peter
authors.initials: P
authors.lastname: Wasswa
authors.forename: de Jager
authors.initials: de J
authors.lastname: Christiaan
mesh_terms: D002648:Child; D002675:Child, Preschool; D003140:Communicable Disease Control / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008288:Malaria / Q000453:epidemiology* / Q000401:mortality*; D008297:Male; D011247:Pregnancy; D015995:Prevalence; D016019:Survival Analysis; D014037:Togo / Q000453:epidemiology