| dc.description.abstract | Background: Malaria control using long-lasting insecticidal nets (LLINs) and indoor residual spraying of insecticide
(IRS) has been associated with reduced transmission throughout Africa. However, the impact of transmission reduction
on the age distribution of malaria cases remains unclear.
Methods: Over a 10-year period (January 2009 to July 2018), outpatient surveillance data from four health facilities
in Uganda were used to estimate the impact of control interventions on temporal changes in the age distribution of
malaria cases using multinomial regression. Interventions included mass distribution of LLINs at all sites and IRS at two
sites.
Results: Overall, 896,550 patient visits were included in the study; 211,632 aged < 5 years, 171,166 aged 5–15 years
and 513,752 > 15 years. Over time, the age distribution of patients not suspected of malaria and those malaria negative
either declined or remained the same across all sites. In contrast, the age distribution of suspected and confirmed
malaria cases increased across all four sites. In the two LLINs-only sites, the proportion of malaria cases in < 5 years
decreased from 31 to 16% and 35 to 25%, respectively. In the two sites receiving LLINs plus IRS, these proportions
decreased from 58 to 30% and 64 to 47%, respectively. Similarly, in the LLINs-only sites, the proportion of malaria
cases > 15 years increased from 40 to 61% and 29 to 39%, respectively. In the sites receiving LLINs plus IRS, these proportions
increased from 19 to 44% and 18 to 31%, respectively.
Conclusions: These findings demonstrate a shift in the burden of malaria from younger to older individuals following
implementation of successful control interventions, which has important implications for malaria prevention,
surveillance, case management and control strategies. | en_US |
