Abstract
BackgroundKoulikoro Health District is one of three districts of Mali where the indoor residual spray (IRS) has been implemented from 2008 to 2016. With widespread of resistance to pyrethroid, IRS was shifted from pyrethroid to pirimiphos-methyl from 2014 to 2016. The objective of this study was to assess the added value of IRS to LLINs on the prevalence of parasitaemia and malaria incidence among children under 10 years old.MethodsA comparative study was carried out to assess the effects of pirimiphos-methyl based IRS on malaria prevalence and incidence among children from 6 months to 10 years old in selected pyrethroid resistance villages of two health districts in Mali: one where IRS was implemented in combination with LLINs (intervention area) and one with LLINs-only (control area). Two cross-sectional surveys were carried out at the beginning (June) and end of the rainy season (October) to assess seasonal changes in malaria parasitaemia by microscopy. A passive detection case (PCD) was set-up in each study village for 9 months to estimate the incidence of malaria using RDT.ResultsThere was an increase of 220% in malaria prevalence from June to October in the control area (14% to 42%) versus only 53% in the IRS area (9.2% to 13.2%). Thus, the proportional rise in malaria prevalence from the dry to the rainy season in 2016 was 4-times greater in the control area compared to the IRS area. The overall malaria incidence rate was 2.7 per 100 person-months in the IRS area compared with 6.8 per 100 person-month in the control areas. The Log-rank test of Kaplan–Meier survival analysis showed that children living in IRS area remain much longer free from malaria (Hazard ratio (HR) = 0.45, CI 95% 0.37–0.54) than children of the control area (P < 0.0001).ConclusionsIRS using pirimiphos-methyl has been successful in reducing substantially both the prevalence and the incidence of malaria in children under 10 years old in the area of pyrethroid resistance of Koulikoro, Mali. Pirimiphos-methyl is a better alternative than pyrethroids for IRS in areas with widespread of pyrethroid resistance.
Highlights
Koulikoro Health District is one of three districts of Mali where the indoor residual spray (IRS) has been implemented from 2008 to 2016
This study aimed to assess effects of a pirimiphos-based IRS by comparing malaria prevalence and incidence in children from 6 months to 10 years old in selected pyrethroid resistance villages of Koulikoro district, where IRS and long-lasting insecticidal nets (LLINs) were used in combination (IRS area), and its neighbor district of Banamba, where only LLINs were used
Study design and sites selection Cross-sectional and passive case detection surveys were undertaken in two health districts to assess the effects of pirimiphos-methyl based IRS in the context of vector resistance to pyrethroids, on Plasmodium falciparum malaria parasitaemia and incidence in children from 6 months to 10 years old
Summary
Koulikoro Health District is one of three districts of Mali where the indoor residual spray (IRS) has been implemented from 2008 to 2016. The objective of this study was to assess the added value of IRS to LLINs on the prevalence of parasitaemia and malaria incidence among children under 10 years old. Funding for control and elimination increased by about US$ 60 million between 2010 and 2015 [1] These investments increased the different control strategies implemented by the different National Malaria Control. Programmes (NMCP) (Prevention, Diagnosis, Treatment, and Surveillance) to achieve the objectives of the Global Technical Strategy 2016–2030 for malaria control [2]. Current prevention strategies are based on the correct and early management of malaria cases, chemoprevention by intermittent preventive treatment (IPT) in pregnant women and seasonal malaria chemoprevention (SMC) in children from 3 to 59 months, the use of long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS) [2, 5, 6]. The rapid spread of vector resistance to insecticide is a challenge for malaria control programmes
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