title: Time series analysis of trends in malaria cases and deaths at hospitals and the effect of antimalarial interventions, 2001-2011, Ethiopia.
abstract: BACKGROUND
  The Government of Ethiopia and its partners have deployed artemisinin-based combination therapies (ACT) since 2004 and long-lasting insecticidal nets (LLINs) since 2005. Malaria interventions and trends in malaria cases and deaths were assessed at hospitals in malaria transmission areas during 2001-2011.
  
  
  METHODS
  Regional LLINs distribution records were used to estimate the proportion of the population-at-risk protected by LLINs. Hospital records were reviewed to estimate ACT availability. Time-series analysis was applied to data from 41 hospitals in malaria risk areas to assess trends of malaria cases and deaths during pre-intervention (2001-2005) and post-interventions (2006-2011) periods.
  
  
  RESULTS
  The proportion of the population-at-risk potentially protected by LLINs increased to 51% in 2011. The proportion of facilities with ACTs in stock exceeded 87% during 2006-2011. Among all ages, confirmed malaria cases in 2011 declined by 66% (95% confidence interval [CI], 44-79%) and SPR by 37% (CI, 20%-51%) compared to the level predicted by pre-intervention trends. In children under 5 years of age, malaria admissions and deaths fell by 81% (CI, 47%-94%) and 73% (CI, 48%-86%) respectively. Optimal breakpoint of the trendlines occurred between January and June 2006, consistent with the timing of malaria interventions. Over the same period, non-malaria cases and deaths either increased or remained unchanged, the number of malaria diagnostic tests performed reflected the decline in malaria cases, and rainfall remained at levels supportive of malaria transmission.
  
  
  CONCLUSIONS
  Malaria cases and deaths in Ethiopian hospitals decreased substantially during 2006-2011 in conjunction with scale-up of malaria interventions. The decrease could not be accounted for by changes in hospital visits, malaria diagnostic testing or rainfall. However, given the history of variable malaria transmission in Ethiopia, more data would be required to exclude the possibility that the decrease is due to other factors.
authors.affiliation: World Health Organization, Global Malaria Program, Geneva, Switzerland.
authors.forename: Maru
authors.initials: M
authors.lastname: Aregawi
authors.affiliation: World Health Organization, Global Malaria Program, Geneva, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Lynch
authors.affiliation: World Health Organization, Country Office, Addis Ababa, Ethiopia.
authors.forename: Worku
authors.initials: W
authors.lastname: Bekele
authors.affiliation: World Health Organization, Country Office, Addis Ababa, Ethiopia.
authors.forename: Henok
authors.initials: H
authors.lastname: Kebede
authors.affiliation: Federal Ministry of Health, Addis Ababa, Ethiopia.
authors.forename: Daddi
authors.initials: D
authors.lastname: Jima
authors.affiliation: Federal Ministry of Health, Addis Ababa, Ethiopia.
authors.forename: Hiwot Solomon
authors.initials: HS
authors.lastname: Taffese
authors.affiliation: Federal Ministry of Health, Addis Ababa, Ethiopia.
authors.forename: Meseret Aseffa
authors.initials: MA
authors.lastname: Yenehun
authors.affiliation: Federal Ministry of Health, Addis Ababa, Ethiopia.
authors.forename: Abraham
authors.initials: A
authors.lastname: Lilay
authors.affiliation: World Health Organization, Global Malaria Program, Geneva, Switzerland.
authors.forename: Ryan
authors.initials: R
authors.lastname: Williams
authors.affiliation: International Research Institute for Climate and Society (IRI), Earth Institute, Columbia University, New York, New York, United States of America.
authors.forename: Madeleine
authors.initials: M
authors.lastname: Thomson
authors.affiliation: World Health Organization, Country Office, Addis Ababa, Ethiopia.
authors.forename: Fatoumata
authors.initials: F
authors.lastname: Nafo-Traore
authors.affiliation: Federal Ministry of Health, Addis Ababa, Ethiopia.
authors.forename: Kesetebirhan
authors.initials: K
authors.lastname: Admasu
authors.affiliation: Federal Ministry of Health, Addis Ababa, Ethiopia.
authors.forename: Tedros Adhanom
authors.initials: TA
authors.lastname: Gebreyesus
authors.affiliation: Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Marc
authors.initials: M
authors.lastname: Coosemans
mesh_terms: D005002:Ethiopia; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D057148:Insecticide-Treated Bednets / Q000706:statistics & numerical data*; D008288:Malaria / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission