Table 1.

Examples of studies that report reduction in the burden of malaria in sub-Saharan Africa.

Country	Study Design	Character of site	Reported reduction	Observed period of decline	Control or comparator		Adjustment for Rainfall	Time of deployment relative to evidence of malaria decline			Reported Reasons
					Non-malarial cases	Non-intervention area or prior data		ACT	ITN	IRS
Coastal Kenya77	Retrospective review of routine HMIS data	One routinely researched site and two adjoining non-research sites	63%, 53% and 28% reduction in malaria cases in 3 district hospitals	1999, 2006	Yes	Yes	Yes	After	After	Not deployed	Malaria control interventions
Ifakara, Tanzania78	Retrospective review of data from cohort studies	Routinely researched site	Reduced from 0.8 to 0.43 episodes per child per year	1995–2000	Yes	No	No	After	After. Net used before were mostly untreated and at coverage less than 20%	Not deployed	Economic improvements, liberalization of health sector and malaria control interventions
Zanzibar, Tanzania44	Before and After intervention	Not routinely researched	77% reduction in malaria admissions	2003–2005	No	Yes	Yes	Before	Before	After	Artemisinin combination Therapy and Insecticide Treated Nets
Mozambique, South Africa and Swaziland79	Before and After intervention	Not routinely researched	> 60% fall in parasite prevalence in all 3 zones studied	1999–2005	No	Yes	No	After	Not deployed	Before	Indoor residual spraying
Guinea-Bissau80	Comparative, Cross-sectional	Routinely researched site	Reduced from 44–79% to 3%	1994, 1999, 2003–4	No	Yes	No**	After	After. Only 5% of nets used before were treated	Not deployed	Untreated bed nets and urbanization
Eritrea81	Before (Retrospective review of routine HMIS data) and After (cross-sectional survey) intervention	Not routinely researched	Decrease in malaria incidence of 83.3% and case fatality by from 0.21 to 0.14%	2000–4	No	Yes	No***	Not deployed	Before	Before	Climate change and malaria control methods (ITNs, IRS and early case detection and treatment)
Rwanda and Ethiopia82	Before and After intervention	Not routinely researched	55% and 73% fall in under-5 in-patient cases in Rwanda & Ethiopia	2001–7	Yes	Yes	No	Before	Before	Not deployed. Used routinely before and after in Ethiopia	Stronger correlation with ACT and ITN scale-up in Rwanda. Less firmer in the case of Ethiopia due to epidemic nature of transmission
Senegal83	Prospective. Nested in clinical trial	Not routinely researched.	Incidence rate from 46.1% to 37.5%	1998 – 2002	No	No	No***	Before	Not deployed	Not deployed	None particularly ACT considered unlikely
Tanzania 84	Before and After intervention	Not routinely researched	4–6-fold reduction in EIR,	1990–4 to 2001–3	No	Yes	No	Not deployed	Before	Not deployed	Deployment of both treated and untreated nets)
South Africa85	Retrospective review of routine HMIS data	Not routinely researched	99% decline in cases and admissions, 97% decline in cases	2000–3	No	Yes	No	Before	Not deployed	Before	Attributable to mass deployment of ACT and IRS
Rwanda 86	Retrospective review of routine HMIS data + House-hold surveys	Not routinely researched	72% decline in confirmed cases, 47% decline in malaria deaths	2006–2010	Yes	Yes	No	Before	Before	Not deployed	Scale-up in ITN and ACT coverage