Continued decline of malaria in The Gambia with implications for elimination

A substantial decline in malaria was reported to have occurred over several years until 2007 in the western part of The Gambia, encouraging consideration of future elimination in this previously highly endemic region. Scale up of interventions has since increased with support from the Global Fund an...

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Bibliographic Details
Published in:	PloS one Vol. 5; no. 8; p. e12242
Main Authors:	Ceesay, Serign J, Casals-Pascual, Climent, Nwakanma, Davis C, Walther, Michael, Gomez-Escobar, Natalia, Fulford, Anthony J C, Takem, Ebako N, Nogaro, Sarah, Bojang, Kalifa A, Corrah, Tumani, Jaye, Momodou Cherno, Taal, Makie Abdoulie, Sonko, Aja Adam Jagne, Conway, David J
Format:	Journal Article
Language:	English
Published:	United States Public Library of Science 18-08-2010 Public Library of Science (PLoS)
Subjects:	Adolescent Adult Analysis Anemia Antigens Child Child, Preschool Children Councils Data Collection Endemic Diseases - statistics & numerical data Epidemiology Female Gambia - epidemiology Geospatial data Health aspects Health care facilities Health surveillance Hospitals Households Humans Incidence Infant Infections Infectious Diseases/Epidemiology and Control of Infectious Diseases Infectious Diseases/Protozoal Infections Infectious Diseases/Tropical and Travel-Associated Diseases Laboratories Laboratories - statistics & numerical data Malaria Malaria - epidemiology Malaria - immunology Male Mathematical models Medical research Plasmodium falciparum Population (statistical) Public health Public Health and Epidemiology/Epidemiology Public Health and Epidemiology/Global Health Public Health and Epidemiology/Infectious Diseases Rural areas Seasonal variations Seasons Serology Statistical models Time Factors Trends Tropical diseases Vector-borne diseases Young Adult Gambia United Kingdom > UK
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Summary:	A substantial decline in malaria was reported to have occurred over several years until 2007 in the western part of The Gambia, encouraging consideration of future elimination in this previously highly endemic region. Scale up of interventions has since increased with support from the Global Fund and other donors. We continued to examine laboratory records at four health facilities previously studied and investigated six additional facilities for a 7 year period, adding data from 243,707 slide examinations, to determine trends throughout the country until the end of 2009. We actively detected infections in a community cohort of 800 children living in rural villages throughout the 2008 malaria season, and assayed serological changes in another rural population between 2006 and 2009. Proportions of malaria positive slides declined significantly at all of the 10 health facilities between 2003 (annual mean across all sites, 38.7%) and 2009 (annual mean, 7.9%). Statistical modelling of trends confirmed significant seasonality and decline over time at each facility. Slide positivity was lowest in 2009 at all sites, except two where lowest levels were observed in 2006. Mapping households of cases presenting at the latter sites in 2007-2009 indicated that these were not restricted to a few residual foci. Only 2.8% (22/800) of a rural cohort of children had a malaria episode in the 2008 season, and there was substantial serological decline between 2006 and 2009 in a separate rural area. Malaria has continued to decline in The Gambia, as indicated by a downward trend in slide positivity at health facilities, and unprecedented low incidence and seroprevalence in community surveys. We recommend intensification of control interventions for several years to further reduce incidence, prior to considering an elimination programme.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Conceived and designed the experiments: SJC CCP DN MW NGE ENT KAB TC AAJS DJC. Performed the experiments: SJC DN NGE AJCF ENT SN MCJ MAT. Analyzed the data: SJC CCP DN MW NGE AJCF ENT DJC. Wrote the paper: SJC CCP DJC.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0012242