Abstract
BackgroundMalariometric information is needed to decide how to introduce malaria vaccines and evaluate their impact in sub-Saharan African countries.MethodsThis cross-sectional study (NCT01954264) was conducted between October and November, 2013, corresponding to the high malaria transmission season, in four sites with Health and Demographic Surveillance Systems (DSS) [two sites with moderate-to-high malaria endemicity in Burkina Faso (Nouna and Saponé) and two sites with low malaria endemicity in Senegal (Keur Socé and Niakhar)]. Children (N = 2421) were randomly selected from the DSS lists of the study sites and were stratified into two age groups (6 months–4 years and 5–9 years). A blood sample was collected from each child to evaluate parasite prevalence of Plasmodium falciparum and other Plasmodium species and gametocyte density by microscopy, and rapid diagnosis test in the event of fever within 24 h. Case report forms were used to evaluate malaria control measures and other factors.ResultsPlasmodium falciparum was identified in 707 (29.2%) children, with a higher prevalence in Burkina Faso than Senegal (57.5 vs 0.9% of children). In Burkina Faso, prevalence was 57.7% in Nouna and 41.9% in Saponé in the 6 months–4 years age group, and 75.4% in Nouna and 70.1% in Saponé in the 5–9 years age group. Infections with other Plasmodium species were rare and only detected in Burkina Faso. While mosquito nets were used by 88.6–97.0 and 64.7–80.2% of children in Burkina Faso and Senegal, other malaria control measures evaluated at individual level were uncommon. In Burkina Faso, exploratory analyses suggested that use of malaria treatment or any other medication within 14 days, and use of insecticide spray within 7 days decreased the prevalence of malaria infection; older age, rural residence, natural floor, grass/palm roof, and unavailability of electricity in the house were factors associated with increased malaria occurrence.ConclusionsPlasmodium falciparum infection prevalence in children younger than 10 years was 57.5% in Burkina Faso and 0.9% in Senegal, and variability was observed, among others, by age, study site and malaria control measures.
Highlights
Malariometric information is needed to decide how to introduce malaria vaccines and evaluate their impact in sub-Saharan African countries
In Senegal, malaria control measures recommended by World Health Organization (WHO), including clinical management of malaria cases using rapid diagnostis test (RDT) and Artemisinin-based combination therapy (ACT), universal coverage of longlasting insecticidal net (LLIN), indoor residual spraying (IRS) and intermittent preventive treatment, have been implemented since 2005, resulting in a decreased malaria burden [16]. These results suggest that most recommended malaria control measures were used at the study site level, except the distribution of insecticide-treated net (ITN) which were not free of charge in Nouna and not included in the policies in Saponé, and the distribution of LLINs which was limited to children younger than 5 years and pregnant women in Niakhar
In Burkina Faso, exploratory analyses suggested that malaria control measures having an impact on the P. falciparum infection status included the use of malaria treatment or other medications in the past 14 days and the use of insecticide sprays
Summary
Malariometric information is needed to decide how to introduce malaria vaccines and evaluate their impact in sub-Saharan African countries. In many African countries, malaria control programmes have been implemented since 2000, including the use of insecticide-treated nets (ITNs), long-lasting insecticidal nets (LLINs), indoor residual spraying of insecticides (IRS), rapid diagnostic tests (RDTs), and effective anti-malaria medicines [1]. These interventions have been associated with a reduction in malaria incidence rates, the increasing problem of multidrug resistance and insecticide resistance highlights the need for new tools, especially in areas of moderate-tohigh malaria transmission intensity (MTI) [1, 3,4,5,6,7]. Before considering its introduction for routine use, the World Health Organization (WHO) recommended further evaluation of its four-dose vaccination schedule in a series of pilot implementations in moderate-to-high transmission settings in sub-Saharan Africa [1]
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