Abstract
BackgroundDespite low endemicity, malaria remains a major health problem in urban areas where a high proportion of fevers are presumptively treated using anti-malarial drugs. Low acquired malaria immunity, behaviour of city-dwellers, access to health care and preventive interventions, and heterogenic suitability of urban ecosystems for malaria transmission contribute to the complexity of the malaria epidemiology in urban areas.MethodsThe study was designed to identify the determinants of malaria transmission estimated by the prevalence of anti-circumsporozoite (CSP) antibodies, the prevalence and density of Plasmodium falciparum infection, and the prevalence of malarial disease in areas of Ouagadougou, Burkina-Faso. Thick blood smears, dried blood spots and clinical status have been collected from 3,354 randomly chosen children aged 6 months to 12 years using two cross-sectional surveys (during the dry and rainy seasons) in eight areas from four ecological strata defined according to building density and land tenure (regular versus irregular). Demographic characteristics, socio-economic information, and sanitary and environmental data concerning the children or their households were simultaneously collected. Dependent variables were analysed using mixed multivariable models with random effects, taking into account the clustering of participants within compounds and areas.ResultsOverall prevalences of CSP-antibodies and P. falciparum infections were 7.7% and 16.6% during the dry season, and 12.4% and 26.1% during the rainy season, respectively, with significant differences according to ecological strata. Malaria risk was significantly higher among children who i) lived in households with lower economic or education levels, iii) near the hydrographic network, iv) in sparsely built-up areas, v) in irregularly built areas, vi) who did not use a bed net, vii) were sampled during the rainy season or ii) had traveled outside of Ouagadougou.ConclusionMalaria control should be focused in areas which are irregularly or sparsely built-up or near the hydrographic network. Furthermore, urban children would benefit from preventive interventions (e.g. anti-vectorial devices or chemoprophylaxis) aimed at reducing malaria risk during and after travel in rural areas.
Highlights
Despite low endemicity, malaria remains a major health problem in urban areas where a high proportion of fevers are presumptively treated using anti-malarial drugs
It has been shown that the level of malaria endemicity in sub-Saharan Africa is generally lower in these areas than in rural areas [1]
A high proportion of fevers are presumptively treated as malaria in urban areas and the anti-malarial drug consumption is higher than in rural areas [4,5]
Summary
Malaria remains a major health problem in urban areas where a high proportion of fevers are presumptively treated using anti-malarial drugs. A high proportion of fevers are presumptively treated as malaria in urban areas and the anti-malarial drug consumption is higher than in rural areas [4,5]. In such context, misdiagnosis of malaria could favour the selection and the spread of drug resistance [4] and contributes to increasing ill-health due to delayed diagnosis of nonmalaria diseases, overburdened health services and increased cost to patient and to health facilities [6]. They are exposed to more severe malaria than those living in rural areas
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