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The burden of malaria in Sudan: incidence, mortality and disability – adjusted life – years
Safa I Abdalla, Elfatih M Malik, Kamil M Ali
Malaria Journal , 2007, DOI: 10.1186/1475-2875-6-97
Abstract: A search for local studies and reports providing epidemiological data on malaria in Sudan was conducted. Preliminary estimates of incidence rate, case fatality rate and mortality rate were developed from the data found. The preliminary estimates were processed in the disease modelling computer software, DisMod II, to produce internally consistent mortality and incidence rates, which were used to calculate DALYs lost due to malaria.Malaria incidence in Sudan was estimated to be about 9 million episodes in 2002 and the number of deaths due to malaria was about 44,000. 2,877,000 DALYs were lost in Sudan in 2002 due to malaria mortality, episodes, anaemia and neurological sequelae. Children under five years of age had the highest burden. Males had the highest incidence and mortality, but females lost more DALYs.Formal health system data underestimated malaria burden. The burden estimates can be useful in informing decision making, although uncertainty around them needs to be quantified. Epidemiological research is needed to fill data gaps and update the estimates.Estimating the burden of malaria is highly needed for evidence based planning of malaria control. In Sudan, malaria has been the subject of a large amount of epidemiological, entomological and biomedical research. Malaria surveillance, as part of the general reporting of health events from health facilities or specific surveillance for epidemic preparedness, provided a wide range of information. This resulted in multiple and diverse sources of information about malaria burden in Sudan, each source serving the purpose for which it was established. The problems with these sources are non-representativeness, variability of the sensitivity and specificity of the diagnostic criteria used and variability of the indices measured. Some may suffer from underreporting. These sources, therefore, could not directly provide a single valid national indicator of malaria burden. Official figures of incidence and mortality refl
Weather-based prediction of Plasmodium falciparum malaria in epidemic-prone regions of Ethiopia II. Weather-based prediction systems perform comparably to early detection systems in identifying times for interventions
Hailay D Teklehaimanot, Joel Schwartz, Awash Teklehaimanot, Marc Lipsitch
Malaria Journal , 2004, DOI: 10.1186/1475-2875-3-44
Abstract: Expected case numbers were modeled using a Poisson regression with lagged weather factors in a 4th-degree polynomial distributed lag model. For each week, the numbers of malaria cases were predicted using coefficients obtained using all years except that for which the prediction was being made. The effectiveness of alerts generated by the prediction system was compared against that of alerts based on observed cases. The usefulness of the prediction system was evaluated in cold and hot districts.The system predicts the overall pattern of cases well, yet underestimates the height of the largest peaks. Relative to alerts triggered by observed cases, the alerts triggered by the predicted number of cases performed slightly worse, within 5% of the detection system. The prediction-based alerts were able to prevent 10–25% more cases at a given sensitivity in cold districts than in hot ones.The prediction of malaria cases using lagged weather performed well in identifying periods of increased malaria cases. Weather-derived predictions identified epidemics with reasonable accuracy and better timeliness than early detection systems; therefore, the prediction of malarial epidemics using weather is a plausible alternative to early detection systems.Malaria epidemics are reported frequently and have caused high morbidity and mortality among all age groups in the African highlands [1-4]. Early detection and accurate forecasting of the time, place and intensity of these epidemics is important for emergency preparedness, planning and response [5,6]. Considerable efforts are being made to promote, develop and implement early warning systems for malaria epidemics in Africa [5,7]. Ideally, public health and vector control workers would have access to a system that alerts them when substantial numbers of excess cases are expected, and such alerts should be sensitive (so that alerts are reliably generated when excess cases are imminent), specific (so that there are few "false alarms") an
Using a geographical information system to plan a malaria control programme in South Africa
Booman,Marlize; Durrheim,Dave N.; La Grange,Kobus; Martin,Carrin; Mabuza,Aaron M.; Zitha,Alpheus; Mbokazi,Frans M.; Fraser,Colleen; Sharp,Brian L.;
Bulletin of the World Health Organization , 2000, DOI: 10.1590/S0042-96862000001200010
Abstract: introduction: sustainable control of malaria in sub-saharan africa is jeopardized by dwindling public health resources resulting from competing health priorities that include an overwhelming acquired immunodeficiency syndrome (aids) epidemic. in mpumalanga province, south africa, rational planning has historically been hampered by a case surveillance system for malaria that only provided estimates of risk at the magisterial district level (a subdivision of a province). methods: to better map control programme activities to their geographical location, the malaria notification system was overhauled and a geographical information system implemented. the introduction of a simplified notification form used only for malaria and a carefully monitored notification system provided the good quality data necessary to support an effective geographical information system. results: the geographical information system displays data on malaria cases at a village or town level and has proved valuable in stratifying malaria risk within those magisterial districts at highest risk, barberton and nkomazi. the conspicuous west-to-east gradient, in which the risk rises sharply towards the mozambican border (relative risk = 4.12, 95% confidence interval = 3.88-4.46 when the malaria risk within 5 km of the border was compared with the remaining areas in these two districts), allowed development of a targeted approach to control. discussion: the geographical information system for malaria was enormously valuable in enabling malaria risk at town and village level to be shown. matching malaria control measures to specific strata of endemic malaria has provided the opportunity for more efficient malaria control in mpumalanga province.
Using a geographical information system to plan a malaria control programme in South Africa  [cached]
Booman Marlize,Durrheim Dave N.,La Grange Kobus,Martin Carrin
Bulletin of the World Health Organization , 2000,
Abstract: INTRODUCTION: Sustainable control of malaria in sub-Saharan Africa is jeopardized by dwindling public health resources resulting from competing health priorities that include an overwhelming acquired immunodeficiency syndrome (AIDS) epidemic. In Mpumalanga province, South Africa, rational planning has historically been hampered by a case surveillance system for malaria that only provided estimates of risk at the magisterial district level (a subdivision of a province). METHODS: To better map control programme activities to their geographical location, the malaria notification system was overhauled and a geographical information system implemented. The introduction of a simplified notification form used only for malaria and a carefully monitored notification system provided the good quality data necessary to support an effective geographical information system. RESULTS: The geographical information system displays data on malaria cases at a village or town level and has proved valuable in stratifying malaria risk within those magisterial districts at highest risk, Barberton and Nkomazi. The conspicuous west-to-east gradient, in which the risk rises sharply towards the Mozambican border (relative risk = 4.12, 95% confidence interval = 3.88-4.46 when the malaria risk within 5 km of the border was compared with the remaining areas in these two districts), allowed development of a targeted approach to control. DISCUSSION: The geographical information system for malaria was enormously valuable in enabling malaria risk at town and village level to be shown. Matching malaria control measures to specific strata of endemic malaria has provided the opportunity for more efficient malaria control in Mpumalanga province.
Malaria hotspot areas in a highland Kenya site are consistent in epidemic and non-epidemic years and are associated with ecological factors
Kacey C Ernst, Samson O Adoka, Dickens O Kowuor, Mark L Wilson, Chandy C John
Malaria Journal , 2006, DOI: 10.1186/1475-2875-5-78
Abstract: To address this issue, spatial distribution of malaria incidence and the relationship of ecological factors to malaria incidence were assessed in the highland area of Kipsamoite, Kenya, from 2001–2004.Clustering of disease in a single geographic "hotspot" area occurred in epidemic and non-epidemic years, with a 2.6 to 3.2-fold increased risk of malaria inside the hotspot, as compared to outside the area (P < 0.001, all 4 years). Altitude and proximity to the forest were independently associated with increased malaria risk in all years, including epidemic and non-epidemic years.In this highland area, areas of high malaria risk are consistent in epidemic and non-epidemic years and are associated with specific ecological risk factors. Ongoing interventions in areas of ecological risk factors could be a cost-effective method of significantly reducing malaria incidence and blunting or preventing epidemics, even in the absence of malaria early warning systems. Further studies should be conducted to see if these findings hold true in varied highland settings.It has been estimated that 34 million individuals in highland areas of East Africa are at risk for malaria [1] and malaria in these highland areas has been responsible for numerous deaths [2]. However, the levels of variation in malaria risk within these highland areas are not well described and only a few studies have investigated risk factors for malaria there [3-5]. Previous studies have demonstrated that malaria cases aggregate from the household to the countrywide level [3,6,7]. The determinants of such clustering are likely due to shared anthropogenic and environmental variables, as well as factors related to contagion such as population density and human interactions [8,9]. Brooker et al demonstrated that there was spatial clustering of malaria cases in children during an epidemic in a single year in highland area of Kenya [3]. However, without data from multiple years, it is difficult to discern if clusters of
The influenza pandemic preparedness planning tool InfluSim
Martin Eichner, Markus Schwehm, Hans-Peter Duerr, Stefan O Brockmann
BMC Infectious Diseases , 2007, DOI: 10.1186/1471-2334-7-17
Abstract: InfluSim is a deterministic compartment model based on a system of over 1,000 differential equations which extend the classic SEIR model by clinical and demographic parameters relevant for pandemic preparedness planning. It allows for producing time courses and cumulative numbers of influenza cases, outpatient visits, applied antiviral treatment doses, hospitalizations, deaths and work days lost due to sickness, all of which may be associated with economic aspects. The software is programmed in Java, operates platform independent and can be executed on regular desktop computers.InfluSim is an online available software http://www.influsim.info webcite which efficiently assists public health planners in designing optimal interventions against pandemic influenza. It can reproduce the infection dynamics of pandemic influenza like complex computer simulations while offering at the same time reproducibility, higher computational performance and better operability.Preparedness against pandemic influenza has become a high priority public health issue and many countries that have pandemic preparedness plans [1]. For the design of such plans, mathematical models and computer simulations play an essential role because they allow to predict and compare the effects of different intervention strategies [2]. The outstanding significance of the tools for purposes of intervention optimization is limited by the fact that they cannot maximize realism, generality and precision at the same time [3]. Public health planners, on the other hand, wish to have an optimal combination of these properties, because they need to formulate intervention strategies which can be generalized into recommendations, but are sufficiently realistic and precise to satisfy public health requirements.Published influenza models which came into application, are represented by two extremes: generalized but over-simplified models without dynamic structure which are publicly available (e.g. [4]), and complex comput
Vector control in a malaria epidemic occurring within a complex emergency situation in Burundi: a case study
Natacha Protopopoff, Michel Van Herp, Peter Maes, Tony Reid, Dismas Baza, Umberto D'Alessandro, Wim Van Bortel, Marc Coosemans
Malaria Journal , 2007, DOI: 10.1186/1475-2875-6-93
Abstract: Twenty nine hills (administrative areas) were selected in collaboration with the provincial health authorities for the vector control interventions combining indoor residual spraying with deltamethrin and insecticide-treated nets. Impact was evaluated by entomological and parasitological surveys. Almost all houses (99%) were sprayed and nets use varied between 48% and 63%. Anopheles indoor resting density was significantly lower in treated as compared to untreated hills, the latter taken as controls. Despite this impact on the vector, malaria prevalence was not significantly lower in treated hills except for people sleeping under a net.Indoor spraying was feasible and resulted in high coverage despite being a logistically complex intervention in the Burundian context (scattered houses and emergency situation). However, it had little impact on the prevalence of malaria infection, possibly because it was implemented after the epidemic's peak. Nevertheless, after this outbreak the Ministry of Health improved the surveillance system, changed its policy with introduction of effective drugs and implementation of vector control to prevent new malaria epidemics.In the absence of effective drugs and sufficient preparedness, present study failed to demonstrate any impact of vector control activities upon the course of a short-duration malaria epidemic. However, the experience gained lead to increased preparedness and demonstrated the feasibility of vector control measures in this specific context.Malaria epidemics are a growing problem in the African highlands with devastating effects on their immunologically naive population [1,2]. When occurring during complex emergency situations their control is even more difficult. According to WHO [3] "a complex emergency is a situation that affects large civilian populations with war or civil strife, food shortages and population displacement, resulting in excess mortality and morbidity". The approach to malaria control in the acute ph
Preparedness planning for pandemic influenza among large US maternity hospitals
RH Beigi,G Davis,J Hodges,A Akers
Emerging Health Threats Journal , 2009, DOI: 10.3134/ehtj.09.002
Abstract: The objective of this investigation was to determine the state of pandemic influenza preparedness and to delineate commonly reported challenges among a sample of larger US national maternity hospitals. This was done given the recent emphasis on hospital disaster planning and the disproportionate morbidity and mortality that pregnant women have suffered in previous influenza pandemics. An internet-based survey was sent to all 12 members of the Council of Women's and Infants' Specialty Hospitals. Questions addressed hospital demographics and overall pandemic preparedness planning, including presence of a pandemic planning committee and the existence of written plans addressing communications, surge capacity, degradation of services, and advance supply planning. Nine of 12 (75%) hospitals responded. All had active pandemic planning committees with identified leadership. The majority (78%) had written formal plans regarding back-up communications, surge/overflow capacity, and degradation of services. However, fewer (44%) reported having written plans in place regarding supply-line/stockpiling of resources. The most common challenges noted were staff and supply coordination, ethical distribution of limited medical resources, and coordination with government agencies. In conclusion, the majority of the Council of Women's and Infants' Specialty Hospitals maternity hospitals have preliminary infrastructure for pandemic influenza planning, but many challenges exist to optimize maternal and fetal outcomes during the next influenza pandemic.
International response to the HIV/AIDS epidemic: planning for success
Piot,Peter; Coll Seck,Awa Marie;
Bulletin of the World Health Organization , 2001, DOI: 10.1590/S0042-96862001001200006
Abstract: more assertive political leadership in the global response to aids in both poor and rich countries culminated in june 2001 at the un general assembly special session on aids. delegates made important commitments there, and endorsed a global strategy framework for shifting the dynamics of the epidemic by simultaneously reducing risk, vulnerability and impact. this points the way to achievable progress in the fight against hiv/aids. evidence of success in tackling the spread of aids comes from diverse programme areas, including work with sex workers and clients, injecting drug users, and young people. it also comes from diverse countries, including india, the russian federation, senegal, thailand, the united republic of tanzania, and zambia. their common feature is the combination of focused approaches with attention to the societywide context within which risk occurs. similarly, building synergies between prevention and care has underpinned success in brazil and holds great potential for sub-saharan africa, where 90% reductions have been achieved in the prices at which antiretroviral drugs are available. success also involves overcoming stigma, which undermines community action and blocks access to services. work against stigma and discrimination has been effectively carried out in both health sector and occupational settings. accompanying attention to the conditions for success against hiv/aids is global consensus on the need for additional resources. the detailed estimate of required aids spending in low- and middle-income countries is us$ 9.2 billion annually, compared to the $ 2 billion currently spent. additional spending should be mobilized by the new global fund to fight aids, tuberculosis and malaria, but needs to be joined by additional government and private efforts within countries, including from debt relief. commitment and capacity to scale up hiv prevention and care have never been stronger. the moment must be seized to prevent a global catastrophe.
International response to the HIV/AIDS epidemic: planning for success  [cached]
Piot Peter,Coll Seck Awa Marie
Bulletin of the World Health Organization , 2001,
Abstract: More assertive political leadership in the global response to AIDS in both poor and rich countries culminated in June 2001 at the UN General Assembly Special Session on AIDS. Delegates made important commitments there, and endorsed a global strategy framework for shifting the dynamics of the epidemic by simultaneously reducing risk, vulnerability and impact. This points the way to achievable progress in the fight against HIV/AIDS. Evidence of success in tackling the spread of AIDS comes from diverse programme areas, including work with sex workers and clients, injecting drug users, and young people. It also comes from diverse countries, including India, the Russian Federation, Senegal, Thailand, the United Republic of Tanzania, and Zambia. Their common feature is the combination of focused approaches with attention to the societywide context within which risk occurs. Similarly, building synergies between prevention and care has underpinned success in Brazil and holds great potential for sub-Saharan Africa, where 90% reductions have been achieved in the prices at which antiretroviral drugs are available. Success also involves overcoming stigma, which undermines community action and blocks access to services. Work against stigma and discrimination has been effectively carried out in both health sector and occupational settings. Accompanying attention to the conditions for success against HIV/AIDS is global consensus on the need for additional resources. The detailed estimate of required AIDS spending in low- and middle-income countries is US$ 9.2 billion annually, compared to the $ 2 billion currently spent. Additional spending should be mobilized by the new global fund to fight AIDS, tuberculosis and malaria, but needs to be joined by additional government and private efforts within countries, including from debt relief. Commitment and capacity to scale up HIV prevention and care have never been stronger. The moment must be seized to prevent a global catastrophe.
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