title: Trends in Malaria in Odisha, India-An Analysis of the 2003-2013 Time-Series Data from the National Vector Borne Disease Control Program.
abstract: BACKGROUND
  Although Odisha is the largest contributor to the malaria burden in India, no systematic study has examined its malaria trends. Hence, the spatio-temporal trends in malaria in Odisha were assessed against the backdrop of the various anti-malaria strategies implemented in the state.
  
  
  METHODS
  Using the district-wise malaria incidence and blood examination data (2003-2013) from the National Vector Borne Disease Control Program, blood examination-adjusted time-trends in malaria incidence were estimated and predicted for 2003-2013 and 2014-2016, respectively. An interrupted time series analysis using segmented regression was conducted to compare the disease trends between the pre (2003-2007) and post-intensification (2009-2013) periods. Key-informant interviews of state stakeholders were used to collect the information on the various anti-malaria strategies adopted in the state.
  
  
  RESULTS
  The state annual malaria incidence declined from 10.82/1000 to 5.28/1000 during 2003-2013 (adjusted annual decline: -0.54/1000, 95% CI: -0.78 to -0.30). However, the annual blood examination rate remained almost unchanged from 11.25% to 11.77%. The keyinformants revealed that intensification of anti-malaria activities in 2008 led to a more rapid decline in malaria incidence during 2009-2013 as compared to that in 2003-2007 [adjusted decline: -0.83 (-1.30 to -0.37) and -0.27 (-0.41 to -0.13), respectively]. There was a significant difference in the two temporal slopes, i.e., -0.054 (-0.10 to -0.002, p = 0.04) per 1000 population per month, between these two periods, indicating almost a 200% greater decline in the post-intensification period. Although, the seven southern high-burden districts registered the highest decline, they continued to remain in that zone, thereby, making the achievement of malaria elimination (incidence <1/1000) unlikely by 2017.
  
  
  CONCLUSIONS
  The anti-malaria strategies in Odisha, especially their intensification since 2008, have helped improve its malaria situation in recent years. These successful measures need to be sustained and perhaps intensified further for eliminating malaria from Odisha.
authors: Centre for Disease Epidemiology and Surveillance, Asian Institute of Public Health, Bhubaneswar, Odisha, India.
authors: Ashirbad
authors: A
authors: Pradhan
authors: Department for International Development, United Kingdom supported Technical and Management Support Team, Bhubaneswar, Odisha, India.
authors: Anita
authors: A
authors: Anasuya
authors: National Vector Borne Disease Control Programme, Department of Health and Family Welfare, Government of Odisha, Bhubaneswar, Odisha, India.
authors: Madan Mohan
authors: MM
authors: Pradhan
authors: Centre for Disease Epidemiology and Surveillance, Asian Institute of Public Health, Bhubaneswar, Odisha, India.
authors: Kavitha
authors: K
authors: Ak
authors: National Vector Borne Disease Control Programme, Department of Health and Family Welfare, Government of Odisha, Bhubaneswar, Odisha, India.
authors: Priyanka
authors: P
authors: Kar
authors: Centre for Disease Epidemiology and Surveillance, Asian Institute of Public Health, Bhubaneswar, Odisha, India.
authors: Krushna Chandra
authors: KC
authors: Sahoo
authors: Center for Global Health and Development, College of Public Health, University of Nebraska Medical Center, Omaha, United States of America.
authors: Pinaki
authors: P
authors: Panigrahi
authors: Centre for Disease Epidemiology and Surveillance, Asian Institute of Public Health, Bhubaneswar, Odisha, India.|Indian Institute of Public Health, Public Health Foundation of India, Bhubaneswar, Odisha, India.
authors: Ambarish
authors: A
authors: Dutta
mesh_terms: D000818:Animals; D000962:Antimalarials / Q000627:therapeutic use; D003140:Communicable Disease Control; D003625:Data Collection; D005843:Geography; D006801:Humans; D007159:Immunologic Tests; D015994:Incidence; D007194:India / Q000453:epidemiology; D007303:Insect Vectors; D065186:Interrupted Time Series Analysis; D016018:Least-Squares Analysis; D008288:Malaria / Q000175:diagnosis / Q000453:epidemiology*; D009032:Mosquito Control; D012044:Regression Analysis; D012621:Seasons; D013997:Time Factors
chemical_list: D000962:Antimalarials