title: High burden of malaria following scale-up of control interventions in Nchelenge District, Luapula Province, Zambia.
abstract: BACKGROUND
  Malaria control interventions have been scaled-up in Zambia in conjunction with a malaria surveillance system. Although substantial progress has been achieved in reducing morbidity and mortality, national and local information demonstrated marked heterogeneity in the impact of malaria control across the country. This study reports the high burden of malaria in Nchelenge District, Luapula Province, Zambia from 2006 to 2012 after seven years of control measures.
  
  
  METHODS
  Yearly aggregated information on cases of malaria, malaria deaths, use of malaria diagnostics, and malaria control interventions from 2006 to 2012 were obtained from the Nchelenge District Health Office. Trends in the number of malaria cases, methods of diagnosis, malaria positivity rate among pregnant women, and intervention coverage were analysed using descriptive statistics.
  
  
  RESULTS
  Malaria prevalence remained high, increasing from 38% in 2006 to 53% in 2012. Increasing numbers of cases of severe malaria were reported until 2010. Intense seasonal malaria transmission was observed with seasonal declines in the number of cases between April and August, although malaria transmission continued throughout the year. Clinical diagnosis without accompanying confirmation declined from 95% in 2006 to 35% in 2012. Intervention coverage with long-lasting insecticide-treated nets and indoor residual spraying increased from 2006 to 2012.
  
  
  CONCLUSIONS
  Despite high coverage with vector control interventions, the burden of malaria in Nchelenge District, Zambia remained high. The high parasite prevalence could accurately reflect the true burden, perhaps in part as a consequence of population movement, or improved access to care and case reporting. Quality information at fine spatial scales will be critical for targeting effective interventions and measurement of progress.
authors.forename: Victor M
authors.initials: VM
authors.lastname: Mukonka
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Chanda
authors.affiliation: W Harry Feinstone Department of Molecular Microbiology & Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA. ubydul.kth@gmail.com.
authors.forename: Ubydul
authors.initials: U
authors.lastname: Haque
authors.forename: Mulakwa
authors.initials: M
authors.lastname: Kamuliwo
authors.forename: Gabriel
authors.initials: G
authors.lastname: Mushinge
authors.forename: Jackson
authors.initials: J
authors.lastname: Chileshe
authors.forename: Kennedy A
authors.initials: KA
authors.lastname: Chibwe
authors.forename: Douglas E
authors.initials: DE
authors.lastname: Norris
authors.forename: Modest
authors.initials: M
authors.lastname: Mulenga
authors.forename: Mike
authors.initials: M
authors.lastname: Chaponda
authors.forename: Mbanga
authors.initials: M
authors.lastname: Muleba
authors.forename: Gregory E
authors.initials: GE
authors.lastname: Glass
authors.forename: William J
authors.initials: WJ
authors.lastname: Moss
mesh_terms: D000818:Animals; D003140:Communicable Disease Control / Q000379:methods*; D005260:Female; D006801:Humans; D008288:Malaria / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control*; D008297:Male; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology / Q000517:prevention & control; D015995:Prevalence; D016019:Survival Analysis; D015024:Zambia / Q000453:epidemiology
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