2009/06/01 by Richard W. Steketee · 1 citation
Medicine · Immunology and Microbiology · #Malaria Research and Control #Mosquito-borne diseases and control #Parasites and Host Interactions
paper · pdf · doi:10.4269/ajtmh.2009.80.879
openalex publication_date 2009/06/01 · openalex created_date 2025/10/10 · openalex updated_date 2026/08/01
1describe remarkable malaria control progress and benefits on the island of Bioko in Equatorial Guinea over the last 4 years. Using a pre-program time period as their comparison, they show that between 2004–2008 with high household coverage of twiceyearly indoor residual spraying (IRS), the introduction of artemisinin combination treatment (ACTs), the use of intermittent preventive treatment in pregnant women (IPTp), and the somewhat more recent introduction of very high coverage with long-lasting insecticide treated mosquito nets (LLINs), they had remarkable impact on malaria infection, disease, and mortality in the population. Although they present their findings fully in their article, some merit repeating. First, their efforts achieved 4 years of very good coverage: spraying IRS every 6 months in typically > 80% of households; achieving 73% LLIN use (not just ownership) in households through house-to-house distribution with instruction and education all provided at no cost to the people; widespread training of doctors and nurses, routine use of diagnostics and free first-line treatment of children 90% and reduced sporozoite rates in the remaining mosquitoes by > 90%. Infection prevalence in 2- to 5-year-old children was down ~57% to 18%; fever rates in the previous 4 weeks were down ~56% to 6.3%; ACT treatment needs decreased by ~62%; anemia rates (Hb < 8 gm/dL) in 2 to 5 year olds were down ~87% to just 2 %. This progress appears to have contributed substantially to a reduction in all-cause under-five mortality from 152 → 55 deaths per 1,000 live births (down ~64%); and the drop occurred rapidly and timed directly with the intervention scale-up. These are findings from a program effort, albeit well monitored and supported with national contributions and much external support from experts and donors. And, the authors must rely on before-scale-up and after-scale-up comparisons. As a consequence, the authors document as well as possible the other potential contributions to improved child survival. The improved economy in Equatorial Guinea caused by the oil industry is explored and the slightly lower rainfall during the 2005–2008 program years is examined in their analysis. They looked for other substantial improvements in disease control efforts (e.g., immunization coverage, other maternal or child health interventions) and found no dramatic scaleup of these programs during this interval to account for their findings. In summary, scaled up malaria control with currently available interventions works; it reduces vector populations and their transmission potential, lowers infection rates, illness rates, anemia rates, and saves lives. This is consistent with the controlled trials for some of the interventions 2–5