Investigating the Effect of Prompt Treatment on Malaria Prevalence in Children Aged below Five Years in Zambia: A Nested Case-Control Study in a Cross-Sectional Survey

Abstract

Background. In a highly malaria endemic country like Zambia, prompt treatment of cases is known to reduce morbidity and mortality; however, it is not known whether it has a role as an effective prevention strategy because of the presence of asymptomatic chronic carriers who do not seek treatment and maintain the reservoirs of infection in the population. This study investigated the role of treatment of malaria cases as a prevention strategy in low, moderate, and high endemic settings. Methods. A nested case-control design was employed using datasets from a large countrywide national Malaria Indicator Survey of 2015. Self-reported malaria cases (n = 209) who took treatment in the two weeks preceding the survey were matched with controls (n = 511) who did not report malaria and did not take treatment during the same period using nearest neighbour propensity score matching for age, sex, and district. The data were analysed using conditional logistic regression in STATA version 15.1. Results. The malaria cases were more likely to be from rural areas (p=0.001), poorest households (p=0.049), and who lived in improvised housing structures (p=0.004) compared with the controls. Data from low and moderate malaria endemic areas did not have sufficient cases for the analysis to proceed; however, data from high endemic areas showed borderline evidence (p=0.054) that prompt treatment reduces the risk of malaria by almost half in the short-term aOR 0.057 (95% CI 0.32–1.01). Conclusion. We found borderline evidence which suggests that prompt treatment of malaria cases even in high endemic areas has potential to reduce the risk of malaria by almost half in the short term.