Conference abstract

Malaria in Tororo district after four rounds of indoor residual spraying: need to test and treat to prevent resurgence, Uganda, 2016

Pan African Medical Journal - Conference Proceedings. 2017:6(21).21 Dec 2017.
doi: 10.11604/pamj-cp.2017.6.21.502

Contact the corresponding author
Keywords: Malaria, mosquito control, Uganda
Plenary

Malaria in Tororo district after four rounds of indoor residual spraying: need to test and treat to prevent resurgence, Uganda, 2016

David Were Oguttu1,&, Joseph Matovu2, David Cyrus Okumu3, Alex Riolexus Ario1, Allen Eva Okullo1, Jimmy Opigo4, Victoria Nankabirwa2

1Uganda Public Health Fellowship Program, Kampala, Uganda, 2School of Public Health, Makerere University, Kampala, Uganda, 3Tororo District Health Office, Tororo, Uganda, 4National Malaria Control Program, Ministry of Health, Kampala, Uganda

&Corresponding author
David Were Oguttu, Uganda Public Health Fellowship Program, Kampala, Uganda

Abstract

Introduction: in 2012, Tororo was a high malaria endemic district in Uganda with community Plasmodium prevalence of 71%. The Ministry of Health introduced universal distribution of long lasting insecticide-treated nets (LLINs) in 2013 and indoor Residual Spraying (IRS) in 2014 to control malaria in the district. We assessed malaria incidence, test positivity rates and Out-patient Department (OPD) attendance due to malaria before and after vector control interventions.

Methods: this study was based on analysis of Health Management Information System, secondary malaria surveillance data for 2,727,850 people who were assessed for malaria at OPD in 61 health facilities from 2012 - 2015. We estimated monthly malaria incidence for the entire population and also separately for < 5 years and ≥ 5 years old before and after introduction of vector control interventions; and determined laboratory test positivity rates and the percentage of malaria cases in OPD per year. We used Chi square for trends to analyze annual change in malaria incidence and logistic regression for monthly reduction trend.

Results: in 2014 when LLINs were used alone, the annual mean monthly malaria incidence fell from 95 in 2013 to 76 cases per 1000 with no significant monthly reduction trend (OR = 0.99, 95% CI = 0.96-1.01, P = 0.37). Among children < 5 years, mean monthly malaria incidence reduced from 130 to 100 cases per 1000 (OR = 0.98, 95% CI = 0.97-1.00, P = 0.08) when LLINs were used alone in 2014, but reduced to 45 per 1000 in 2015 when IRS was combined with LLINs (OR = 0.94, 95% CI = 0.91-0.996, P < 0.0001). Among individuals aged ≥ 5 years, mean monthly malaria incidence reduced from 59 to 52 cases per 1000 (OR = 0.99, 95% CI = 0.97-1.02, P = 0.8) when LLINs were used alone in 2014, but reduced significantly to 25 per 1000 in 2015 when LLINs were used in combination with IRS (OR = 0.91, 95% CI = 0.88-0.94, P<0.0001). The slide positivity rate reduced from 45% in 2013 to 21% in 2015 (P = 0.004) and OPD attendance due to malaria declined from 52% in 2013 to 30% in 2015 (P = 0.0017).

Conclusion: malaria incidence in Tororo district declined rapidly following the introduction of integrated vector control interventions. Universal distribution of LLINs alone was not associated with significant reduction in malaria incidence in the district.