Increased uptake of intermittent preventive treatment for malaria in pregnant women in Zambia(2006–2012):Potential determinants and highlight of lessons learnt

Objective:To assess potential determinants of uptake and highlight lessons learnt from the implementation of intermittent preventive treatment(IPTp), given to pregnant women as early as possible during the second trimester in Zambia.Methods: Data from four national malaria surveys(2006, 2008, 2010, 2012) were reviewed, and proportions of pregnant women attending antenatal clinics(ANCs) who received two or more doses of sulfadoxine–pyrimethamine(IPTp2) were compared by place of residence, education level, and wealth status. Malaria cases and deaths in pregnant women, from Health Information Management System 2011–2013, were analyzed to determine malaria burden in pregnancy in Zambia. A multiple logistic regression model was applied to identify potential determinants of IPTp uptake.Results: The proportion of pregnant women who took IPTp at ANCs increased from near zero at inception in 2001 to 61.9% in 2006; and to 72% by 2012(P < 0.001), and overall the uptake was 1.41 times higher in 2012 compared to 2006. From 2006 to 2012,IPTp2 uptake among women with no formal education increased from 51% to 68%(P < 0.1). Likewise, uptake among pregnant women with the lowest wealth index increased from 58.2% to 61.2%. By 2012, IPTp uptake among pregnant women within the lowest wealth index increased to a similar level as the women with high wealth index(P = 0.05). Incidence of malaria cases, hospital admissions and mortality during pregnancy decreased between 2011 and 2013. Overall, increased IPTp uptake was associated with being in urban areas(OR = 1.56, 95% CI: 1.39–1.74), having college(OR = 1.83,95% CI: 1.25–2.75) or secondary education(OR = 1.68, 95% CI: 1.44–1.96) or of being of higher wealth status(OR = 1.86, 95% CI: 1.60–2.17).Conclusions: Zambia has increased IPTp uptake through ANC for all women. The malaria control program has contributed to increasing access to health services and reducing demographic and socioeconomic disparities.

Dengue fever outbreaks in Eritrea,2005-2015 A case for strengthening surveillance,control and reporting

Background:The geographic distribution and burden of dengue is increasing globally.This study aims to evaluate dengue outbreaks and to substantiate the need for strengthened surveillance,reporting and control in Eritrea.Methods:Data from two cross-sectional dengue epidemic investigations in 2005 and 2010 were analyzed.Samples were tested for dengue virus-specific IgM and IgG antibodies using capture enzyme-linked immunosorbent assays.Dengue vectors’breeding attributes were characterized and epidemic risk indices determined.National routine surveillance weekly reports from 2005 to the second quarter of 2015 were analyzed for spatiotemporal trends.Results:Dengue outbreaks increased in Eritrea from 2005 to 2015 with clinical presentation varying markedly among patients.The house and container indices for Aedes aegypti were 40 and 39.6%respectively,with containers having A.aeqypti varying significantly(P<0.04).Serum from 33.3%(n=15)and 88%(n=26)of clinical dengue cases in Aroget sub-Zoba(district)of Gash Barka Zoba(region)contained anti-DENV IgM antibody in 2005 and 2006,respectively.The national surveillance data from 2005 to 2015 indicate an overall spatiotemporal increase of dengue fever.Conclusions:The increase in dengue outbreaks has been confirmed in Eritrea and necessitates strengthening of surveillance and health worker and laboratory capacity,as well as targeted vector control interventions.