Abstract
BackgroundThere have been few investigations evaluating the burden of malaria disease at district level in the Republic of Congo since the introduction of artemisinin-based combination therapies (ACTs). The main objective of this study was to document laboratory-confirmed cases of malaria using microscopy and/or rapid diagnostic tests (RDTs) in children and pregnant women attending selected health facilities in Brazzaville and Pointe Noire, the two main cities of the country. Secondly, P. falciparum genetic diversity and multiplicity of infection during the malaria transmission season of October 2011 to February 2012 in these areas were described.MethodsThree and one health facilities were selected in Brazzaville and Pointe-Noire as sentinel sites for malaria surveillance. Children under 15 years of age and pregnant women were enrolled if study criteria were met and lab technicians used RDT and/or microscopy to diagnose malaria. In order to determine the multiplicity of infection, parasite DNA was extracted from RDT cassette and msp2 P.falciparum genotyped.ResultsMalaria prevalence among more than 3,000 children and 700 pregnant women ranged from 8 to 29%, and 8 to 24% respectively depending on health center locality. While health workers did not optimize use of RDTs, microscopy remained a reference diagnostic tool. Quality control of malaria diagnosis at the reference laboratory showed acceptable health centre performances. P. falciparum genetic diversity determination using msp2 gene marker ranged from 9 to 20 alleles and remains stable while multiplicity of infection (mean of 1.7clone/infected individual) and parasite densities in clinical isolates were lower than previously reported.ConclusionsThese findings are consistent with a reduction of malaria transmission in the two areas. This study raises the issue of targeted training for health workers and sustained availability of RDTs in order to improve quality of care through optimal use of RDTs.
Highlights
There have been few investigations evaluating the burden of malaria disease at district level in the Republic of Congo since the introduction of artemisinin-based combination therapies (ACTs)
These findings are consistent with a reduction of malaria transmission in the two areas
This study raises the issue of targeted training for health workers and sustained availability of Rapid diagnostic test (RDT) in order to improve quality of care through optimal use of RDTs
Summary
There have been few investigations evaluating the burden of malaria disease at district level in the Republic of Congo since the introduction of artemisinin-based combination therapies (ACTs). Deployment of various control tools has boosted malaria control in sub-Saharan Africa This includes wide deployment of artemisinin-combination therapies (ACTs), insecticide-treated nets and in some places targeted indoor residual spraying (IRS) of insecticides. Treatment based solely on clinical suspicion is warranted when resources for parasitological diagnosis are not available [2,3]. This strategy would ensure the therapeutic longevity of ACTs through protection against development of parasite resistance. Performances of laboratory technicians using microscopy or RDTs are not yet assessed, despite its influence on application of guidelines for malaria treatment and subsequently on the overall impact on malaria control
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