title: The changing burden of malaria and association with vector control interventions in Zambia using district-level surveillance data, 2006-2011.
abstract: BACKGROUND
  Malaria control was strengthened in Zambia over the past decade. The two primary interventions for vector control are indoor residual spraying (IRS) and long-lasting insecticide-treated nets (LLINs). Using passive malaria surveillance data collected from 2006 to 2011 through the Zambian District Health Information System, the associations between increased coverage with LLINs and IRS and the burden of malaria in Zambia were evaluated.
  
  
  METHODS
  National passive malaria surveillance data from 2006 to 2011 were analysed. A district-level, random-effects model with Poisson regression was used to explore the association between malaria cases and coverage with LLINs and IRS. Malaria cases and LLINs and IRS coverage were mapped to visualize spatiotemporal variation in malaria for each year.
  
  
  RESULTS
  From 2006-2011, 24.6 million LLINs were distributed and 6.4 million houses were sprayed with insecticide. Coverage with LLINs was not uniformly distributed over the study period and IRS was targeted to central and southern districts where malaria transmission was low. LLIN coverage was associated with a reduction in malaria cases, although an increase in the number of malaria cases was reported in some districts over the study period. A high burden of malaria persisted in north-eastern Zambia, whereas a reduction in the number of reported malaria cases was observed in western and southern Zambia.
  
  
  CONCLUSIONS
  Enhanced and targeted interventions in north-eastern Zambia where the burden of malaria remains high, as well as efforts to sustain low malaria transmission in the south-west, will be necessary for Zambia to achieve the national goal of being malaria free by 2030.
authors.forename: Mulakwa
authors.initials: M
authors.lastname: Kamuliwo
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Chanda
authors.affiliation: W, Harry Feinstone Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA. ubydul.kth@gmail.com.
authors.forename: Ubydul
authors.initials: U
authors.lastname: Haque
authors.forename: Mercy
authors.initials: M
authors.lastname: Mwanza-Ingwe
authors.forename: Chadwick
authors.initials: C
authors.lastname: Sikaala
authors.forename: Cecilia
authors.initials: C
authors.lastname: Katebe-Sakala
authors.forename: Victor M
authors.initials: VM
authors.lastname: Mukonka
authors.forename: Douglas E
authors.initials: DE
authors.lastname: Norris
authors.forename: David L
authors.initials: DL
authors.lastname: Smith
authors.forename: Gregory E
authors.initials: GE
authors.lastname: Glass
authors.forename: William J
authors.initials: WJ
authors.lastname: Moss
mesh_terms: D002648:Child; D002675:Child, Preschool; D006801:Humans; D057148:Insecticide-Treated Bednets; D007306:Insecticides; D008288:Malaria / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control* / Q000635:transmission; D009032:Mosquito Control / Q000379:methods*; D062486:Public Health Surveillance; D015024:Zambia / Q000453:epidemiology
chemical_list: D007306:Insecticides