Abstract
Burkina Faso has one of the highest malaria burdens in sub-Saharan Africa despite the mass deployment of insecticide-treated nets (ITNs) and use of seasonal malaria chemoprevention (SMC) in children aged up to 5 years. Identification of risk factors for Plasmodium falciparum infection in rural Burkina Faso could help to identify and target malaria control measures. A cross-sectional survey of 1,199 children and adults was conducted during the peak malaria transmission season in the Cascades Region of south-west Burkina Faso in 2017. Logistic regression was used to identify risk factors for microscopically confirmed P. falciparum infection. A malaria transmission dynamic model was used to determine the impact on malaria cases averted of administering SMC to children aged 5–15 year old. P. falciparum prevalence was 32.8% in the study population. Children aged 5 to < 10 years old were at 3.74 times the odds (95% CI = 2.68–5.22, P < 0.001) and children aged 10 to 15 years old at 3.14 times the odds (95% CI = 1.20–8.21, P = 0.02) of P. falciparum infection compared to children aged less than 5 years old. Administration of SMC to children aged up to 10 years is predicted to avert an additional 57 malaria cases per 1000 population per year (9.4% reduction) and administration to children aged up to 15 years would avert an additional 89 malaria cases per 1000 population per year (14.6% reduction) in the Cascades Region, assuming current coverage of pyrethroid-piperonyl butoxide ITNs. Malaria infections were high in all age strata, although highest in children aged 5 to 15 years, despite roll out of core malaria control interventions. Given the burden of infection in school-age children, extension of the eligibility criteria for SMC could help reduce the burden of malaria in Burkina Faso and other countries in the region.
Highlights
Impressive reductions in malaria occurred throughout sub-Saharan Africa from 2000 to 2 0151
In many high-burden countries, parasite prevalence rates and mortality from malaria remain obstinately high despite roll out of key malaria control interventions including insecticidetreated nets (ITNs), use of seasonal malaria chemoprevention (SMC) in children aged less than five years, and diagnosis and treatment using artemisinin combination therapy (ACTs)[2]
Most study participants were illiterate (70.5%, 845/1199) and farmers (54.8%, 657/1199), whereas 43.5% (522/1199) of participants were not engaged in income generating work either because they were too young or because they were too old to work. 90.7% of study participants (1,087/1,199) reported sleeping under a bednet the previous night. 9.2% (110/1199) of the population reported using a topical repellent in the last week, while 6.2% (74/1199) reported using household insecticides
Summary
Impressive reductions in malaria occurred throughout sub-Saharan Africa from 2000 to 2 0151. Increases in malaria cases are being observed despite national ITN distribution campaigns in 2010, 2013, 2016 and 2019 and introduction of seasonal malaria chemoprevention (SMC) in children aged 3 to 59 months since 2014. A cross-sectional survey was carried out in 2017 to determine the prevalence of P. falciparum infection in different age groups and identify risk factors in south-west Burkina Faso. These data were used to parameterise a mathematical model of malaria transmission to explore how expanding the age range for using SMC would impact the malaria burden in the study area
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