# name
Changes in malaria burden and transmission in sentinel sites
                after the roll-out of long-lasting insecticidal nets in Papua
                New Guinea

# metadata.dc.description.abstract[].value
BACKGROUND: Papua New Guinea exhibits a complex malaria
                epidemiology due to diversity in malaria parasites, mosquito
                vectors, human hosts, and their natural environment.
                Heterogeneities in transmission and burden of malaria at various
                scales are likely to affect the success of malaria control
                interventions, and vice-versa. This manuscript assesses changes
                in malaria prevalence, incidence and transmission in sentinel
                sites following the first national distribution of long-lasting
                insecticidal nets (LLINs). METHODS: Before and after the
                distribution of LLINs, data collection in six purposively
                selected sentinel sites included clinical surveillance in the
                local health facility, household surveys and entomological
                surveys. Not all activities were carried out in all sites.
                Mosquitoes were collected by human landing catches. Diagnosis of
                malaria infection in humans was done by rapid diagnostic test,
                light microscopy and PCR for species confirmation. RESULTS:
                Following the roll-out of LLINs, the average monthly malaria
                incidence rate dropped from 13/1,000 population to 2/1,000
                (incidence rate ratio = 0.12; 95 % CI: 0.09-0.17; P < 0.001).
                The average population prevalence of malaria decreased from 15.7
                % pre-LLIN to 4.8 % post-LLIN (adjusted odds ratio = 0.26; 95 %
                CI: 0.20-0.33; P < 0.001). In general, reductions in
                incidence and prevalence were more pronounced in infections with
                P. falciparum than with P. vivax. Additional morbidity
                indicators (anaemia, splenomegaly, self-reported fever) showed a
                decreasing trend in most sites. Mean Anopheles man biting rates
                decreased from 83 bites/person/night pre-LLIN to 31 post-LLIN (P
                = 0.008). Anopheles species composition differed between sites
                but everywhere diversity was lower post-LLIN. In two sites,
                post-LLIN P. vivax infections in anophelines had decreased but
                P. falciparum infections had increased despite the opposite
                observation in humans. CONCLUSIONS: LLIN distribution had
                distinct effects on P. falciparum and P. vivax. Higher
                resilience of P. vivax may be attributed to relapses from
                hypnozoites and other biological characteristics favouring the
                transmission of P. vivax. The effect on vector species
                composition varied by location which is likely to impact on the
                effectiveness of LLINs. In-depth and longer-term epidemiological
                and entomological investigations are required to understand when
                and where residual transmission occurs and whether observed
                changes are sustained.

# metadata.dc.relation.isformatof[].value
Reproducció del document publicat a:
                http://dx.doi.org/10.1186/s13071-016-1635-x

# metadata.dc.source[].value
Articles publicats en revistes (ISGlobal)

# metadata.dc.title[].value
Changes in malaria burden and transmission in sentinel sites
                after the roll-out of long-lasting insecticidal nets in Papua
                New Guinea