Malaria Epidemics and Interventions, Kenya, Burundi, S. Sudan, and Ethiopia
Malaria Epidemics and Interventions, Kenya, Burundi, S. Sudan, and Ethiopia
Quantitative data on the onset and evolution of malaria epidemics are scarce. We review case studies from recent African Plasmodium falciparum epidemics (Kisii and Gucha Districts, Kenya, 1999; Kayanza Province, Burundi, 2000-2001; Aweil East, southern Sudan, 2003; Gutten and Damot Gale, Ethiopia, 2003-2004). We highlight possible epidemic risk factors and review delays in epidemic detection and response (up to 20 weeks), essentially due to poor case reporting and analysis or low use of public facilities. Epidemics lasted 15-36 weeks, and patients' age profiles suggested departures from classical notions of epidemic malaria everywhere but Burundi. Although emergency interventions were mounted to expand inpatient and outpatient treatment access, we believe their effects were lessened because of delays, insufficient evaluation of disease burden, lack of evidence on how to increase treatment coverage in emergencies, and use of ineffective drugs.
Plasmodium falciparum malaria epidemics were detected in 41 African sites from 1997 through 2002. A total of 125 million persons are considered at risk for malaria epidemics, with an estimated yearly death rate of 155,000 to 310,000.
Research on malaria epidemics mostly concerns long-range forecasting, early warning, and early detection (improved understanding of the role of temperature, rainfall, and El Niño-Southern Oscillation events, development of epidemic detection thresholds. Malaria epidemics evolve rapidly and most often occur in remote, underresourced settings without proper surveillance. Data on their evolution may thus go unrecorded, which prevents the development of evidence-based recommendations on effective epidemic control.
Recently, Médecins Sans Frontières (MSF) intervened in several P. falciparum malaria epidemics in remote or conflict-affected sub-Saharan African settings. We present case studies from these interventions (Kisii and Gucha Districts, Kenya, 1999; Kayanza Province, Burundi, 2000-2001; Gutten and Damot Gale, Ethiopia, 2003-2004; Aweil East County, southern Sudan, 2003). We also describe the epidemics and possible factors that explain their occurrence, review challenges encountered in their detection and control, and make recommendations for epidemic prevention and control policies. This article reports health facility-based morbidity and mortality data. Findings on deaths in the community will be presented elsewhere (manuscript in review).
Abstract and Introduction
Abstract
Quantitative data on the onset and evolution of malaria epidemics are scarce. We review case studies from recent African Plasmodium falciparum epidemics (Kisii and Gucha Districts, Kenya, 1999; Kayanza Province, Burundi, 2000-2001; Aweil East, southern Sudan, 2003; Gutten and Damot Gale, Ethiopia, 2003-2004). We highlight possible epidemic risk factors and review delays in epidemic detection and response (up to 20 weeks), essentially due to poor case reporting and analysis or low use of public facilities. Epidemics lasted 15-36 weeks, and patients' age profiles suggested departures from classical notions of epidemic malaria everywhere but Burundi. Although emergency interventions were mounted to expand inpatient and outpatient treatment access, we believe their effects were lessened because of delays, insufficient evaluation of disease burden, lack of evidence on how to increase treatment coverage in emergencies, and use of ineffective drugs.
Introduction
Plasmodium falciparum malaria epidemics were detected in 41 African sites from 1997 through 2002. A total of 125 million persons are considered at risk for malaria epidemics, with an estimated yearly death rate of 155,000 to 310,000.
Research on malaria epidemics mostly concerns long-range forecasting, early warning, and early detection (improved understanding of the role of temperature, rainfall, and El Niño-Southern Oscillation events, development of epidemic detection thresholds. Malaria epidemics evolve rapidly and most often occur in remote, underresourced settings without proper surveillance. Data on their evolution may thus go unrecorded, which prevents the development of evidence-based recommendations on effective epidemic control.
Recently, Médecins Sans Frontières (MSF) intervened in several P. falciparum malaria epidemics in remote or conflict-affected sub-Saharan African settings. We present case studies from these interventions (Kisii and Gucha Districts, Kenya, 1999; Kayanza Province, Burundi, 2000-2001; Gutten and Damot Gale, Ethiopia, 2003-2004; Aweil East County, southern Sudan, 2003). We also describe the epidemics and possible factors that explain their occurrence, review challenges encountered in their detection and control, and make recommendations for epidemic prevention and control policies. This article reports health facility-based morbidity and mortality data. Findings on deaths in the community will be presented elsewhere (manuscript in review).
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