Abstract

BackgroundFollowing the deployment of new recommendations for malaria control according to the World Health Organization, an estimation of the real burden of the disease is needed to better identify populations at risk and to adapt control strategies. The aim of the present study was to estimate the clinical burden of malaria among febrile children aged less than 11 years, before and after six-year of deployment of malaria control strategies in different areas of Gabon.MethodsCross-sectional surveys were carried out in health care facilities at four locations: two urban areas (Libreville and Port-Gentil), one semi-urban area (Melen) and one rural area (Oyem), between 2005 and 2011. Febrile paediatric patients, aged less than 11 years old were screened for malaria using microscopy. Body temperature, history of fever, age, sex, and location were collected.ResultsA total of 16,831 febrile children were enrolled; 78.5% (n=13,212) were less than five years old. The rate of Plasmodium falciparum-infection was the lowest in Port-gentil (below 10%) and the highest at Oyem (above 35%). Between 2005 and 2008, malaria prevalence dropped significantly from 31.2% to 18.3%, followed by an increase in 2011 in Libreville (24.1%), Port-Gentil (6.5%) and Oyem (44.2%) (p<0.01). Median age among the infected patients increased throughout the study period reaching 84 (60–108) months in Libreville in 2011 (p<0.01). From 2008, at all sites, children older than five years were more frequently infected; the risk of being infected significantly increased with time, ranging from 0.37 to 1.50 in 2005 and from 2.03 to 5.10 in 2011 in this group (p<0.01). The risk of being P. falciparum-infected in children aged less than five years old significantly decreased from 2008 to 2011 (p<0.01).ConclusionsThis study shows an increased risk of malaria infection in different areas of Gabon with over-five year-old children tending to become the most at-risk population, suggesting a changing epidemiology. Moreover, the heterogeneity of the malaria burden in the country highlights the importance of maintaining various malaria control strategies and redefining their implementation.

Highlights

  • Following the deployment of new recommendations for malaria control according to the World Health Organization, an estimation of the real burden of the disease is needed to better identify populations at risk and to adapt control strategies

  • A trend towards a higher risk of P. falciparum infection in children aged more than five years was reported, indicating the need to implement appropriate malaria control strategies

  • Recruitment was carried out at four health care centres: i) the Malaria Clinical and Operational Research Unit (MCORU) in Libreville, the capital city of Gabon; ii), the regional hospital of Melen (HREM), a semi-urban area located at 11 km north of Libreville; iii) the regional hospital of Oyem (CHRO), a rural northern area; and, iv) the regional hospital of Port-Gentil (CHRP), an urban area located on a peninsula on the west coast

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Summary

Introduction

Following the deployment of new recommendations for malaria control according to the World Health Organization, an estimation of the real burden of the disease is needed to better identify populations at risk and to adapt control strategies. The aim of the present study was to estimate the clinical burden of malaria among febrile children aged less than 11 years, before and after six-year of deployment of malaria control strategies in different areas of Gabon. Children under five years and pregnant women are the most affected, constituting the main target population of new malaria control strategies as recommended by the World Health Organization (WHO) [1]. The aim of the study was to estimate the clinical malaria burden among febrile children less than 11 years of age before and after six-year of deployment of malaria control strategies in different areas of Gabon

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