Abstract
BackgroundProgress in controlling malaria has stalled in recent years. Today the malaria burden is increasingly concentrated in a few countries, including Burkina Faso, where malaria is not declining. A cohort study was conducted to identify risk factors for malaria infection in children in southwest Burkina Faso, an area with high insecticide-treated net (ITN) coverage and insecticide-resistant vectors.MethodsIncidence of Plasmodium falciparum infection was measured in 252 children aged 5 to 15 years, using active and passive detection, during the 2017 transmission season, following clearance of infection. Demographic, socio-economic, environmental, and entomological risk factors, including use of ITNs and insecticide resistance were monitored.ResultsDuring the six-month follow-up period, the overall incidence of P. falciparum infection was 2.78 episodes per child (95% CI = 2.66–2.91) by microscopy, and 3.11 (95% CI = 2.95–3.28) by polymerase chain reaction (PCR). The entomological inoculation rate (EIR) was 80.4 infective bites per child over the six-month malaria transmission season. At baseline, 80.6% of children were reported as sleeping under an ITN the previous night, although at the last survey, 23.3% of nets were in poor condition and considered no longer protective. No association was found between the rate of P. falciparum infection and either EIR (incidence rate ratio (IRR): 1.00, 95% CI: 1.00–1.00, p = 0.08) or mortality in WHO tube tests when vectors were exposed to 0.05% deltamethrin (IRR: 1.05, 95% CI: 0.73–1.50, p = 0.79). Travel history (IRR: 1.52, 95% CI: 1.45–1.59, p < 0.001) and higher socio-economic status were associated with an increased risk of P. falciparum infection (IRR: 1.05, 95% CI: 1.00–1.11, p = 0.04).ConclusionsIncidence of P. falciparum infection remains overwhelmingly high in the study area. The study findings suggest that because of the exceptionally high levels of malaria transmission in the study area, malaria elimination cannot be achieved solely by mass deployment of ITNs and additional control measures are needed.
Highlights
Progress in controlling malaria has stalled in recent years
Full list of author information is available at the end of the article
Insecticide resistance is only one important factor affecting the efficacy of nets, since insecticide-treated net (ITN) coverage, durability and whether people sleep under nets, as well as mosquito biting time and behaviour are important
Summary
Progress in controlling malaria has stalled in recent years. Today the malaria burden is increasingly concentrated in a few countries, including Burkina Faso, where malaria is not declining. Despite unprecedented declines in malaria between 2000 and 2015, of which 68% can be attributed to the scale-up of insecticide-treated nets (ITNs) [2], recent years have seen stagnating progress in high burden countries [1] Reasons for this lack of progress are unclear, but may include incomplete coverage of ITNs, nets in poor condition and malaria vectors resistant to the pyrethroid insecticides used for ITNs. Burkina Faso, along with 10 other high-burden countries in Africa, plus India, has been designated as a High Burden to High Impact country by the World Health Organization (WHO) and the Roll Back Malaria Partnership which calls for an aggressive new approach to accelerate malaria control [3]. Social and environmental factors, including access to healthcare, socio-economic status (SES) and house construction, found to be protective against malaria in other studies [19], may impact malaria risk in Burkina Faso
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
