title: Measuring the association between artemisinin-based case management and malaria incidence in southern Vietnam, 1991-2010.
abstract: In addition to being effective, fast-acting, and well tolerated, artemisinin-based combination therapies (ACTs) are able to kill certain transmission stages of the malaria parasite. However, the population-level impacts of ACTs on reducing malaria transmission have been difficult to assess. In this study on the history of malaria control in Vietnam, we assemble annual reporting on malaria case counts, coverage with insecticide-treated nets (ITN) and indoor residual spraying (IRS), and drug purchases by provincial malaria control programs from 1991 to 2010 in Vietnam's 20 southern provinces. We observe a significant negative association between artemisinin use and malaria incidence, with a 10% absolute increase in the purchase proportion of artemisinin-containing regimens being associated with a 29.1% (95% confidence interval: 14.8-41.0%) reduction in slide-confirmed malaria incidence, after accounting for changes in urbanization, ITN/IRS coverage, and two indicators of health system capacity. One budget-related indicator of health system capacity was found to have a smaller association with malaria incidence, and no other significant factors were found. Our findings suggest that including an artemisinin component in malaria drug regimens was strongly associated with reduced malaria incidence in southern Vietnam, whereas changes in urbanization and coverage with ITN or IRS were not.
authors: Corey M
authors: CM
authors: Peak
authors: Phung Duc
authors: PD
authors: Thuan
authors: Amadea
authors: A
authors: Britton
authors: Tran Dang
authors: TD
authors: Nguyen
authors: Marcel
authors: M
authors: Wolbers
authors: Ngo Viet
authors: NV
authors: Thanh
authors: Caroline O
authors: CO
authors: Buckee
authors: Maciej F
authors: MF
authors: Boni
mesh_terms: D000818:Animals; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D037621:Artemisinins / Q000008:administration & dosage*; D019090:Case Management; D016001:Confidence Intervals; D009033:Culicidae / Q000469:parasitology; D006801:Humans; D015994:Incidence; D007303:Insect Vectors / Q000469:parasitology; D057148:Insecticide-Treated Bednets; D008288:Malaria / Q000188:drug therapy / Q000453:epidemiology* / Q000635:transmission; D015233:Models, Statistical; D009032:Mosquito Control; D010961:Plasmodium / Q000187:drug effects*; D014744:Vietnam / Q000453:epidemiology
chemical_list: D000890:Anti-Infective Agents; D037621:Artemisinins; C031327:artemisinin