title: Changes in malaria epidemiology in a rural area of Cubal, Angola.
abstract: BACKGROUND
  Scarce information about malaria epidemiology in Angola has been published. The objective of this study is to describe the epidemiology of malaria at the Hospital Nossa Senhora da Paz (Cubal, Angola) and the fatality rate due to malaria (total and in children under five years) in the last five years.
  
  
  METHODS
  A retrospective, observational study was performed at the Hospital Nossa Senhora da Paz, a 400-bed rural hospital located in Benguela Province of Angola. The study population included all patients who attended the hospital from January 2009 to December 2013. Outcome variables were calculated as follows: the percentage of malaria cases (number of positive thick blood films, divided by the total thick blood films performed); the percentage of in-patients for malaria (number of in-patients diagnosed with malaria, divided by the total number of in-patients); and, the fatality rate (number of deaths due to malaria divided by the number of positive thick blood films).
  
  
  RESULTS
  Overall, 23,106 thick blood films were performed, of which 3,279 (14.2%) were positive for Plasmodium falciparum infection. During this five-year period, a reduction of 40% (95% CI 37-43%, p < 0.001) in the malaria-positive slides was detected. Distribution of positive-malaria slides showed a seasonal distribution with a peak from December to March (rainy season). An average annual reduction of 52% (95% CI 50-54%, p < 0.001) in the admissions due to malaria was observed. The overall fatality rate due to malaria was 8.3%, and no significant differences in the annual fatality rate were found (p = 0.553).
  
  
  CONCLUSIONS
  A reduction in the number of malaria cases and the number of admissions due to malaria has been observed at the Hospital Nossa Senhora da Paz, during the last five years, and incidence along the study period showed a seasonal distribution. All this information could be useful when deciding which malaria control strategies have to be implemented in this area.
authors.affiliation: Department of Infectious Diseases, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain. fmsalvad@vhebron.net.
authors.forename: Fernando
authors.initials: F
authors.lastname: Salvador
authors.forename: Yolima
authors.initials: Y
authors.lastname: Cossio
authors.forename: Marta
authors.initials: M
authors.lastname: Riera
authors.forename: Adrián
authors.initials: A
authors.lastname: Sánchez-Montalvá
authors.forename: Cristina
authors.initials: C
authors.lastname: Bocanegra
authors.forename: Jacobo
authors.initials: J
authors.lastname: Mendioroz
authors.forename: Arlette N
authors.initials: AN
authors.lastname: Eugenio
authors.forename: Elena
authors.initials: E
authors.lastname: Sulleiro
authors.forename: Warren
authors.initials: W
authors.lastname: Meredith
authors.forename: Teresa
authors.initials: T
authors.lastname: López
authors.forename: Milagros
authors.initials: M
authors.lastname: Moreno
authors.forename: Israel
authors.initials: I
authors.lastname: Molina
mesh_terms: D000810:Angola / Q000453:epidemiology; D002675:Child, Preschool; D005260:Female; D006780:Hospitals, Rural; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D016778:Malaria, Falciparum / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D012189:Retrospective Studies; D012424:Rural Population; D016019:Survival Analysis