Abstract
ObjectiveTo investigate if the first national insecticide-treated bed-net campaign in Burkina Faso, done in 2010, was followed by a decrease in childhood malaria in a district with high baseline transmission of the disease.MethodsWe obtained data on the prevalence of Plasmodium falciparum parasitaemia in children aged 2 weeks to 36 months from malaria surveys in 2009 and 2011. We assessed morbidity in children younger than 5 years by comparing data from the Nouna health district’s health management information system before and after the campaign in 2010. We analysed mortality data from 2008 to 2012 from Nouna’s health and demographic surveillance system.FindingsThe bed-net campaign was associated with an increase in the reported use of insecticide-treated nets. In 2009, 73% (630/869) of children reportedly slept under nets. In 2011, 92% (449/487) did. The campaign had no effect on the proportion of young children with P. falciparum parasitaemia after the rainy season; 52% (442/858) in 2009 and 53% (263/499) in 2011. Cases of malaria increased markedly after the campaign, as did the number of children presenting with other diseases. The campaign was not associated with any changes in child mortality.ConclusionThe 2010 insecticide-treated net campaign in Burkina Faso was not associated with a decrease in care-seeking for malaria or all-cause mortality in children younger than 5 years. The most likely explanation is the high coverage of nets in the study area before the campaign which could have had an effect on mosquito vectors, limiting the campaign’s impact.
Highlights
Malaria remains a major threat to the health of some three billion people in 108 countries where the disease is endemic.[1]
Surveys indicate that insecticide-treated nets have reduced the malaria burden and all-cause child mortality in Africa,[6] most recent reports of success in the region have come from islands, the peripheries of endemic areas and smaller countries with substantial external support.[3,5,7]
The reported use of insecticide-treated nets during the night before the survey increased from 73% (630/869) in 2009 to 92% (449/487) in 2011, overall, the prevalence of parasitaemia was similar in the two years, at around 52% (442/858 and 263/499)
Summary
Malaria remains a major threat to the health of some three billion people in 108 countries where the disease is endemic.[1]. After a partially successful malaria eradication campaign in the 1950s and 1960s, the global burden of the disease increased between the 1970s and the 1990s due to a combination of fewer control measures and the development of resistance to antimalarial drugs and insecticides.[3,4] After the start of the Roll Back Malaria Initiative in 1998, the global malaria burden decreased again, thanks to the large-scale introduction of interventions such as artemisinin-based combination therapy and insecticide-treated bed nets.[2,3] This was associated with a reduction in malaria transmission intensity and the malaria burden in sub-Saharan Africa.[3,5] surveys indicate that insecticide-treated nets have reduced the malaria burden and all-cause child mortality in Africa,[6] most recent reports of success in the region have come from islands, the peripheries of endemic areas and smaller countries with substantial external support.[3,5,7] The reported malaria burden has changed little in highly endemic African countries despite increased coverage of insecticide-treated nets.[7,8,9,10,11,12,13,14,15,16] few data are available from countries in sub-Saharan Africa in which the malaria burden is highest.[2]
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