Peer Review #1 of "Malaria prevalence and incidence in an isolated, meso-endemic area of Mozambique (v0.2)" [peer_review]

D Ishengoma
2015 unpublished
Isolated areas, such as the 2x7 km peninsula of Linga Linga in Mozambique, are the places where malaria might be most easily eliminated. Currently available control strategies include long-lasting insecticidal bed nets impregnated with pyrethroid insecticides (LLINs), rapid diagnostic tests (RDTs) for diagnosis and artemisinin combination therapy (ACT) for treatment and these were applied on the peninsula. In 2007, following a census of the population and mapping of 500 households, five annual
more » ... ll age prevalence surveys were conducted. Information on LLIN use, house construction, and animal ownership was obtained. A spatially structured generalized additive model indicated that malaria risk was greatest towards the northern end of the peninsula and that people living in houses with grass or thatch roofs had a greater risk of malaria than those living in houses with corrugated iron roofs. Incidence peaked nine weeks after rainfall (r 2 = 0.34, p = 0.0002). From 2009 incidence was measured at a centrally based project clinic. The proportion of under nine year old resident attendees diagnosed with malaria decreased significantly from 48% in 2009, to 35% in 2010 and 25% in 2011. At the same time there was a shift in the peak age of cases from 1-4 year olds to 5-9 year olds. Nevertheless, in order to further reduce malaria transmission in an area such as Linga Linga additional vector control measures need to be considered. PeerJ reviewing PDF | Manuscript to be reviewed 1 2 Malaria prevalence and incidence in an isolated, meso-endemic area 3 of Mozambique 4 5 JD Charlwood, EVE Tomás, M Bragança, N Cuamba, M Alifrangis, M Stanton 6 Abstract 7 8 Isolated areas, such as the 2x7 km peninsula of Linga Linga in Mozambique, are the places 9 where malaria might be most easily eliminated. Currently available control strategies 10 include long-lasting insecticidal bed nets impregnated with pyrethroid insecticides (LLINs), 11 rapid diagnostic tests (RDTs) for diagnosis and artemisinin combination therapy (ACT) for 12 treatment and these were applied on the peninsula. In 2007, following a census of the 13 population and mapping of 500 households, five annual all age prevalence surveys were 14 conducted. Information on LLIN use, house construction, and animal ownership was 15 obtained. A spatially structured generalized additive model indicated that malaria risk was 16 greatest towards the northern end of the peninsula and that people living in houses with 17 grass or thatch roofs had a greater risk of malaria than those living in houses with 18 corrugated iron roofs. Incidence peaked nine weeks after rainfall (r 2 = 0.34, p = 0.0002). 19 From 2009 incidence was measured at a centrally based project clinic. The proportion of 20 under nine year old resident attendees diagnosed with malaria decreased significantly 21 from 48% in 2009, to 35% in 2010 and 25% in 2011. At the same time there was a shift in 22 the peak age of cases from 1-4 year olds to 5-9 year olds. Nevertheless, in order to further 23 reduce malaria transmission in an area such as Linga Linga additional vector control 24 measures need to be considered. 25 Background 26 27 Malaria remains a serious problem in Mozambique. According to UNICEF it is the leading 28 killer of children, contributing to around 33% of all child deaths. Overall more deaths have 29 been attributed to it (28.8%) than to any other single cause, including HIV/AIDS 30 [www.unicef.org/mozambique/child_survival_2933.html]. Figures like these, from many 31 areas of Africa, have led to major funding initiatives directed towards its control. These PeerJ reviewing PDF | Manuscript to be reviewed 32 have met with considerable success, much of which has occurred through widespread use 33 of Long Lasting Insecticidal Nets (LLINs) for prevention, and the use of highly effective 34 drugs, the artemisinin-based combination therapies (ACTs), for treatment. These successes 35 have prompted the idea that the disease can locally be eliminated, eventually leading to its 36 global eradication. 37 38 Isolated areas, such as islands and peninsulas, that are surrounded by mosquito-hostile 39 environments, be that sea, desert or uninhabited land, are the places most susceptible to 40 malaria elimination. In such places there is much less immigration and emigration of 41 vectors (and people) than in more connected environments (Aregawi et al., 2011, 42 Hagmann et al.
doi:10.7287/peerj.1370v0.2/reviews/1 fatcat:gkmuyyk4ondjji3vg6bighsezy