Elimination or more accurate estimation? Investigation of trends in malaria diagnoses in the Ouest Department of Haiti from 2008 to 2017.

BACKGROUND:According to the 2016 World Malaria Report, the malaria incidence in Haiti declined by > 40% between 2010 and 2015. Though elimination efforts have likely contributed, this time period also corresponded to a national change in diagnostic methods. METHODS:Monthly reports of aggregated patient data were acquired from five clinics in the Ouest Department of Haiti. Generalized linear models were used to compare the number of febrile patients tested, the number of positive tests, and the proportion of tests that were positive (TRP) before and after the national adoption of rapid diagnostic tests (RDTs). RESULTS:Prior to the earthquake when microcopy was used for diagnosis, a total of 1,727 patients with 557 (32.3%) positive; post-earthquake testing was reduced and the TPR was variable; during the post recovery period when RDTs were used exclusivly, a total of 5,132 patients were tested using RDTs, only 83 (1.62%) were positive. Compared to the pre-earthquake period, there was a 69% increase in the number of patients tested (IRR: 1.69; 95% CI IRR 1.59, 2.79), and a 97.0% decrease in the proportion of patients with a positive test result (IRR: 0.03; 95% CI IRR 0.02, 0.04) in the post-recovery period. CONCLUSIONS:While the decline in malaria indicators between 2010 and 2015 has been cited as evidence of progress towards elimination, these reports derived estimates of the malaria burden in Haiti using two different diagnostic tests. Thus, comparison of these periods in the context of malaria elimination should be made with caution

Mantegna a Mantova, 1460-1506

Catalogo della mostra dedicata ad Andrea Mantegna, nel quinto centenario della morte. Il saggio di inquadramento generale degli anni mantovani di Andrea Mantegna, chiarisce le relazioni di Mantegna con l'ambiente mantovano, e le schede illustrano le singole opere esposte in mostra

Malaria diagnostics given to febrile patients and positive tests by clinic.

<p>Malaria diagnostics given to febrile patients and positive tests by clinic.</p

Actual and predicted number of positive tests before and after the adoption of RDTs.

<p>The actual number of positive tests and number of positive tests predicted from the regression model are shown along with a linear fit with a 95% confidence interval. Two clusters emerge, the values from period 1 (squares) when microscopy was used and the values from period 2 (circules), once RDTs were adopted. Period 2 was omitted from the regression due to large amounts of missing data or months with less than 20 febrile patients tested for malaria.</p

Malaria diagnostics given to febrile patients and positive tests by year.

<p>Malaria diagnostics given to febrile patients and positive tests by year.</p

Geographical location of medical clinics from the Ouest Department of Haiti.

<p>The geographical locations of the clinics within the African Methodist Episcopal Church Service and Development Agency (AME-SADA) network are presented with respect to the national administrative boundaries (departments in inset, communes in map). These include Fond Baptiste, Leger, and Pont Matheaux from the commune of Arcahaie (estimate population 118,501); along with Bellanger and Source Matelas from the commune of Cabaret (estimated population 62,063).</p