Abstract
BackgroundThe malaria burden has decreased significantly in recent years in Africa through the widespread use of artemisinin-based combination therapy (ACT) and long-lasting insecticide-treated nets (LLINs). However, the occurrence of malaria resurgences, the loss of immunity of exposed populations constitute among other factors, serious concerns about the future of malaria elimination efforts. This study investigated the evolution of malaria morbidity in Dielmo (Senegal) before and after the implementation of LLINs.MethodsA longitudinal study was carried out in Dielmo over eight years, from July 2007 to July 2015. In July 2008, LLINs were offered to all villagers, and in July 2011 and August 2014 the LLINs were renewed. A survey on LLINs use was done each quarter of the year. Thick smears stained with Giemsa, a rapid diagnostic test (RDT) and quantitative polymerase chain reaction (PCR) methods were performed for all cases of fever to assess malaria clinical attacks. Malaria cases were treated with ACT since June 2006.ResultsMalaria morbidity has decreased significantly since the implementation of LLINs in Dielmo, together with ACT. However, malaria resurgences have occurred twice during the seven years of LLINs use. These resurgences occurred the first time during the third year after the introduction of LLINs (aIRR (adjusted incidence-rate ratio) [95%CI] = 5.90 [3.53; 9.88] p< 0.001) and a second time during the third year after the renewal of LLINs (aIRR [95%CI] = 5.60 [3.34; 9.39] p< 0.001). Sixty-nine percent (69%) of the nets tested for their long-lasting insecticidal activity remained effective after 3 years of use.ConclusionGood management of malaria cases by the use of ACT as first-line treatment against malaria in addition to the use of LLINs has significantly reduced malaria in Dielmo and allowed to reach the phase of pre-elimination of the disease. However, the occurrence of malaria resurgences raised serious concerns about malaria elimination, which would require additional tools in this village.
Highlights
The worldwide burden of malaria has decreased significantly during this last decade
The reduction of malaria morbidity and mortality is more pronounced in some African countries, where control strategies based on long-lasting insecticide-treated nets (LLINs) and artemisinin-based combination therapy (ACT) have been scaled up at the national level [1]
Adults became more vulnerable; before the introduction of long-lasting insecticidetreated nets (LLINs), only 18% of malaria cases occurred among adults, whereas since the implementation of nets, approximately 50% of cases were observed among adults (Fig 1)
Summary
The worldwide burden of malaria has decreased significantly during this last decade. The reduction of malaria morbidity and mortality is more pronounced in some African countries, where control strategies based on long-lasting insecticide-treated nets (LLINs) and artemisinin-based combination therapy (ACT) have been scaled up at the national level [1]. The treatment of malaria has changed from monotherapy to combination therapy, and since 2010 ACT has been used as first-line treatment in all malaria-endemic countries [3]. The combination of these two strategies has led to an important decrease in malaria [6,7,8,9,10]. The malaria burden has decreased significantly in recent years in Africa through the widespread use of artemisinin-based combination therapy (ACT) and long-lasting insecticidetreated nets (LLINs). This study investigated the evolution of malaria morbidity in Dielmo (Senegal) before and after the implementation of LLINs
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