Abstract
BackgroundThe morbidity of malaria has steady declined in the urban regions of Gabon between 2000 and 2008, but caution should be exercised before generalizing this trend to the whole country because this finding has not been systematically confirmed in remote rural provinces.MethodsWe conducted a retrospective survey using data on malaria cases recorded in North Eastern Gabon between 2006 and 2013 at health facilities in Makokou. Malaria data were analyzed, and associations with annual variations and patient age were assessed.ResultsA global increase in clinical and confirmed malaria cases was observed over the study period. The rate of infection was significantly higher in children aged between 0 to 4 years than in children of 5 years and above, and in adults. Contrary to prior observations in urban and semi-urban areas of Gabon, malaria burden remained mostly unchanged or even increased in Makokou in the Ogooué-Ivindo province during these last 8 years.ConclusionsThe persistence of Plasmodium falciparum pockets of sustained malaria transmission in rural Gabon may be related to an inadequate coverage of key interventions, to poor treatment seeking behavior and/or to a decline efficacy of treatments. Our results highlight the need to better adapt malaria control strategies to local epidemiological contexts and to environmental constraints. Equitable delivery of health service to hard-to-reach populations constitutes a challenging issue for the health authorities of Gabon.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1456-4) contains supplementary material, which is available to authorized users.
Highlights
The morbidity of malaria has steady declined in the urban regions of Gabon between 2000 and 2008, but caution should be exercised before generalizing this trend to the whole country because this finding has not been systematically confirmed in remote rural provinces
Almost all episodes of malaria are due to P. falciparum and resistance to conventional antimalarial drugs is widespread [2,3]
In the absence of a nationwide system that routinely records malaria morbidity, trends are estimated by collecting data from a few selected public health facilities or sentinel sites located in, or adjacent to, urban areas such as the hospitals in Libreville, Port-Gentil, Lambaréné, and Franceville [9]
Summary
The morbidity of malaria has steady declined in the urban regions of Gabon between 2000 and 2008, but caution should be exercised before generalizing this trend to the whole country because this finding has not been systematically confirmed in remote rural provinces. Almost all episodes of malaria are due to P. falciparum and resistance to conventional antimalarial drugs is widespread [2,3]. The widespread resistance to sulfadoxine-pyrimethamine is Assele et al BMC Public Health (2015) 15:81 yearbook for Gabon reports a similar number of cases, the figures do not demonstrate any decline over the same period with 123,708, 183,085, and 131,149 malaria episodes reported in 2006, 2007, and 2008, respectively [8]. Children >5 years of age became the most at-risk subpopulation These improvements have been attributed to the implementation of expanded malaria control initiatives in Gabon from 2003, including intermittent preventive treatment of pregnant women, the distribution insecticide-treated bednets (ITNs), and increased availability of effective antimalarial drugs [10,11]
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