Correction to: Baseline incidence of meningitis, malaria, mortality and other health outcomes in infants and young sub-Saharan African children prior to the introduction of the RTS,S/AS01E malaria vaccine

An amendment to this paper has been published and can be accessed via the original article.

Prevention of re-establishment of malaria

The current consensus on prevention of re-establishment of malaria is based on the following principles: (1) Fundamental role of general health services; (2) Surveillance; (3) Vector control; (4) Border actions; (5) Intersectoral collaboration. These principles are critically reviewed, and it is pointed out that alertness of the general health services to suspected malaria (vigilance) needs to be maintained everywhere, while health education is rational only if targeting high-risk sub-populations. It is argued that prevention of re-establishment of malaria transmission should be integrated with prevention of malaria mortality in cases of imported malaria, and that this requires collaboration with entities dealing with travellers’ health and the availability of chemoprophylaxis and other measures for travellers to malaria endemic countries.

Galvanizing Communities towards Zero Malaria in Nigeria: An Account of 2019 World Malaria Day in Bayelsa State

Nigeria had a vision of zero death from malaria by 2020 and was making efforts to achieve the goal. Reducing malaria mortality or eliminating malaria requires community ownership and active participation. This paper describes activities carried out in Bayelsa State to commemorate the 2019 World Malaria Day – an important global event towards eliminating malaria. Several organizations in the state collaborated to organize the event and used various media to spread the key messages of the day. Inadequate resources however limited full commemoration. A better- funded event in the future has potential for a larger impact.

Baseline incidence of meningitis, malaria, mortality and other health outcomes in infants and young sub-Saharan African children prior to the introduction of the RTS,S/AS01E malaria vaccine

Background The lack of background disease incidence rates in sub-Saharan countries where the RTS,S/AS01E malaria vaccine is being implemented may hamper the assessment of vaccine safety and effectiveness. This study aimed to document baseline incidence rates of meningitis, malaria, mortality, and other health outcomes prior to vaccine introduction through the Malaria Vaccine Implementation Programme. Methods An ongoing disease surveillance study is combining prospective cohort event monitoring and hospital-based disease surveillance in three study sites in Ghana and Kenya. An interim analysis was performed on the prospective cohort in which children were enrolled in two age-groups (the 5 to 17 months or 6 to 12 weeks age-group), capturing data in the framework of routine medical practice before the introduction of the malaria vaccine. Incidence and mortality rates were computed with 95% confidential intervals (CI) using an exact method for a Poisson variable. Results This analysis includes 14,329 children; 7248 (50.6%) in the 6 to 12 weeks age-group and 7081 (49.4%) in the 5 to 17 months age-group. In the 5 to 17 months age-group (where the malaria vaccine was planned to be subsequently rolled out) the meningitis, malaria, severe malaria and cerebral malaria incidences were 92 (95% CI 25–236), 47,824 (95% CI 45,411–50,333), 1919 (95% CI 1461–2476) and 33 (95% CI 1–181) per 100,000 person-years, respectively. The all-cause mortality was 969 (95% CI 699–1310) per 100,000 person-years. Conclusion Incidence estimates of multiple health outcomes are being generated to allow before-after vaccine introduction comparisons that will further characterize the benefit-risk profile of the RTS,S/AS01E vaccine. Trial registration: clinicaltrials.gov NCT02374450.

Constructing a malaria-related health service readiness index and assessing its association with child malaria mortality: an analysis of the Burkina Faso 2014 SARA data

Background The Service Availability and Readiness Assessment surveys generate data on the readiness of health facility services. We constructed a readiness index related to malaria services and determined the association between health facility malaria readiness and malaria mortality in children under the age of 5 years in Burkina Faso. Methods Data on inpatients visits and malaria-related deaths in under 5-year-old children were extracted from the national Health Management Information System in Burkina Faso. Bayesian geostatistical models with variable selection were fitted to malaria mortality data. The most important facility readiness indicators related to general and malaria-specific services were determined. Multiple correspondence analysis (MCA) was employed to construct a composite facility readiness score based on multiple factorial axes. The analysis was carried out separately for 112 medical centres and 546 peripheral health centres. Results Malaria mortality rate in medical centres was 4.8 times higher than that of peripheral health centres (3.5% vs. 0.7%, p < 0.0001). Essential medicines was the domain with the lowest readiness (only 0.1% of medical centres and 0% of peripheral health centres had the whole set of tracer items of essential medicines). Basic equipment readiness was the highest. The composite readiness score explained 30 and 53% of the original set of items for medical centres and peripheral health centres, respectively. Mortality rate ratio (MRR) was by 59% (MRR = 0.41, 95% Bayesian credible interval: 0.19–0.91) lower in the high readiness group of peripheral health centres, compared to the low readiness group. Medical centres readiness was not related to malaria mortality. The geographical distribution of malaria mortality rate indicate that regions with health facilities with high readiness show lower mortality rates. Conclusion Performant health services in Burkina Faso are associated with lower malaria mortality rates. Health system readiness should be strengthened in the regions of Sahel, Sud-Ouest and Boucle du Mouhoun. Emphasis should be placed on improving the management of essential medicines and to reducing delays of emergency transportation between the different levels of the health system.

Constructing a malaria-related health service readiness index and assessing its association with child malaria mortality: an analysis of the Burkina Faso 2014 SARA data

Abstract Background: The Service Availability and Readiness Assessment (SARA) surveys generate data on the readiness of health facility services. We constructed a readiness index related to malaria services and determined the association between health facility malaria readiness and malaria mortality in children under the age of 5 years in Burkina Faso. Methods: Data on inpatients visits and malaria-related deaths in under 5-year-old children were extracted from the national Health Management Information System (HMIS) in Burkina Faso. Bayesian geostatistical models with variable selection were fitted to malaria mortality data. The most important facility readiness indicators related to general and malaria-specific services were determined. Multiple correspondence analysis (MCA) was used to construct a composite facility readiness score based on multiple factorial axes. The analysis was carried out separately for 112 medical centres and 546 peripheral health centres. Results: Malaria mortality rate in medical centres was 4.8 times higher than that of peripheral health centres (3.46% vs. 0.72%, p<0.0001). Essential medicines was the domain with the lowest readiness (only 0.1% of medical centres and 0% of peripheral health centres had the whole set of tracer items of essential medicines). Basic equipment readiness was the highest. The composite readiness score explained 30% and 53% of the original set of items for medical centres and peripheral health centres, respectively. Mortality rate ratio (MRR) was by 59% (MRR = 0.41, 95% Bayesian credible interval (BCI): 0.19-0.91) lower in the high readiness group of peripheral health centres, compared to the low readiness group. Medical centres readiness was not related to malaria mortality. The geographical distribution of malaria mortality rate indicate that regions with health facilities with high readiness show lower mortality rates. Conclusion: Performant health services in Burkina Faso are associated with lower malaria mortality rates. Health system readiness should be strengthened in the regions of Sahel, Sud-Ouest and Boucle du Mouhoun. Emphasis should be given to improving the management of essential medicines and to reducing delays of emergency transportation between the different levels of the health system. Keywords: Bayesian geostatistical models, Burkina Faso, Composite readiness index, Malaria, Service Availability and Readiness Assessment

Malaria: Trend of Burden and Impact of Control Strategies

Since antiquity, malaria had plagued humans claiming millions of lives annually around the world. In addition to its health toll, billions of dollars are lost every year to the exorbitant cost of treatment, premature death, loss of opportunities, capital intensive public health and government interventions to curb the menace. This had intensified global malaria eradication efforts over the last few decades leading to the successful elimination of the disease from most developed countries drastically reducing global malaria mortality to hundreds of thousands yearly. Still, developing countries of the world especially those in tropical Africa remain the worst hit and children are the most vulnerable group generally accounting for > 50% of all malaria mortality. The world actually experienced a giant leap forward between 2000 and 2015 when global malaria mortality rate declined by a remarkable 25% and by a significant 69% in children less than five. Also, during this period a staggering 70% of malaria cases were averted due to strengthened malaria intervention. Some of this step forward was also attributed to increasing urbanization and overall economic development across the nation’s leading to improved housing and nutrition. However, years later, progress has been relatively slower and seemed to have stalled. Nonetheless, the impacts of control strategies have saved millions of lives universally. But to save more lives and eliminate malaria from highest risk countries like in tropical Africa, more efforts are required at both international and national capacity through the funding of research and malaria projects, effective surveillance and response, strengthened health system and mosquito vector control strategies, and development of new, improved antimalarial intervention tools like diagnostics, prophylactics, therapeutics and vaccines. Also, the role of human activity and lifestyle in the fight against malaria cannot be overemphasized.