BACKGROUND: In 2004, Togo adopted a regional strategy for malaria control that made use of insecticide-treated
nets (ITNs), followed by the use of rapid diagnostic tests (RDTs), artemisinin-based combination therapy (ACT).
Community health workers (CHWs) became involved in 2007. In 2010, the impact of the implementation of these
new malaria control strategies had not yet been evaluated. This study sought to assess the trends of malaria
incidence and mortality due to malaria in Est Mono district from 2005 to 2010.
METHODS: Secondary data on confirmed and suspected malaria cases reported by health facilities from 2005 to
2010 were obtained from the district health information system. Rainfall and temperature data were provided by
the national Department of Meteorology. Chi square test or independent student’s t-test were used to compare
trends of variables at a 95% confidence interval. An interrupted time series analysis was performed to assess the
effect of meteorological factors and the use of ACT and CHWs on morbidity and mortality due to malaria.
RESULTS: From January 2005 to December 2010, 114,654 malaria cases (annual mean 19,109 ± 6,622) were reported
with an increase of all malaria cases from 10,299 in 2005 to 26,678 cases in 2010 (p<0.001). Of the 114,654 malaria
cases 52,539 (45.8%) were confirmed cases. The prevalence of confirmed malaria cases increased from 23.1 per
1,000 in 2005 to 257.5 per 1,000 population in 2010 (p <0.001). The mortality rate decreased from 7.2 per 10,000 in
2005 to 3.6 per 10,000 in 2010 (p <0.001), with a significant reduction of 43.9% of annual number of death due to
malaria. Rainfall (β-coefficient = 1.6; p = 0.05) and number of CHWs trained (β-coefficient = 6.8; p = 0.002) were
found to be positively correlated with malaria prevalence.
CONCLUSION: This study showed an increase of malaria prevalence despite the implementation of the use of ACT
and CHW strategies. Multicentre data analysis over longer periods should be carried out in similar settings to assess
the impact of malaria control strategies on the burden of the disease. Integrated malaria vector control
management should be implemented in Togo to reduce malaria transmission.