Surveillance de la rougeole en Côte d’Ivoire de 2010 à 2022: Épidémiologie – Facteurs associés – Recommandations

BackgroundEvidence suggests that women who give birth in a health facility have lower odds of experiencing pregnancy complications and significantly reduced risk of death from pregnancy-related causes compared to women who deliver at home. Establishing the association between high-risk fertility behaviour (HRFB) and health facility delivery is imperative to inform intervention to help reduce maternal mortality. This study examined the association between HRFB and health facility delivery in West Africa.MethodsData for the study were extracted from the most recent Demographic and Health Surveys of twelve countries in West Africa conducted from 2010 to 2020. A total of 69,479 women of reproductive age (15–49 years) were included in the study. Place of delivery was the outcome variable in this study. Three parameters were used as indicators of HRFB based on previous studies. These were age at first birth, short birth interval, and high parity. Multivariable binary logistic regression analysis was performed to examine the association between HRFB and place of delivery and the results were presented using crude odds ratio (cOR) and adjusted odds ratio (aOR), with their respective 95% confidence interval (CI).ResultsMore than half (67.64%) of the women delivered in a health facility. Women who had their first birth after 34 years (aOR = 0.52; 95% CI = 0.46–0.59), those with short birth interval (aOR = 0.91; 95% CI = 0.87–0.96), and those with high parity (aOR = 0.58; 95% CI = 0.55–0.60) were less likely to deliver in a health compared to those whose age at first delivery was 18-34 years, those without short birth interval, and those with no history of high parity, respectively. The odds of health facility delivery was higher among women whose first birth occurred at an age less than 18 years compared to those whose age at first birth was 18-34 years (aOR = 1.17; 95% CI = 1.07–1.28).ConclusionHRFB significantly predicts women's likelihood of delivering in a health facility in West Africa. Older age at first birth, shorter birth interval, and high parity lowered women’s likelihood of delivering in a health facility. To promote health facility delivery among women in West Africa, it is imperative for policies and interventions on health facility delivery to target at risk sub-populations (i.e., multiparous women, those with shorter birth intervals and women whose first birth occurs at older maternal age). Contraceptive use and awareness creation on the importance of birth spacing should be encouraged among women of reproductive age in West Africa.

Ebola: worldwide dissemination risk and response priorities

In sub-Saharan Africa (SSA), every 1 in 12 children under five dies every year compared with 1 in 147 children in the high-income regions. Studies have shown an association between birth intervals and pregnancy outcomes such as low birth weight, preterm birth, and intrauterine growth restriction. In this study, we examined the association between birth interval and under-five mortality in eight countries in West Africa. A secondary analysis of the Demographic and Health Survey (DHS) data from eight West African countries was carried out. The sample size for this study comprised 52,877 childbearing women (15-49 years). A bivariate logistic regression analysis was carried out and the results were presented as crude odds ratio (cOR) and adjusted odds ratios (aOR) at 95% confidence interval (CI). Birth interval had a statistically significant independent association with under-five mortality, with children born to mothers who had >2 years birth interval less likely to die before their fifth birthday compared to mothers with ≤2 years birth interval [cOR = 0.56; CI = 0.51 − 0.62], and this persisted after controlling for the covariates [aOR = 0.55; CI = 0.50 − 0.61]. The country-specific results showed that children born to mothers who had >2 years birth interval were less likely to die before the age of five compared to mothers with ≤2 years birth interval in all the eight countries. In terms of the covariates, wealth quintile, mother's age, mother's age at first birth, partner's age, employment status, current pregnancy intention, sex of child, size of child at birth, birth order, type of birth, and contraceptive use also had associations with under-five mortality. We conclude that shorter birth intervals are associated with higher under-five mortality. Other maternal and child characteristics also have associations with under-five mortality. Reproductive health interventions aimed at reducing under-five mortality should focus on lengthening birth intervals. Such interventions should be implemented, taking into consideration the characteristics of women and their children.

Fifteen years ago, a review of HIV programmes across southern Africa concluded that fewer men were receiving antiretroviral therapy (ART) compared with women [1]. Recognition of this delayed engagement with care, which persists today [2], has grown in recent years, with several recent studies showing that, compared with women, men present with more advanced HIV disease and associated higher mortality risk, are less likely to start ART and are less likely to be retained in care [3,4]. In this issue of AIDS, a prospective cohort study [5] provides outcomes of rapid ART initiation among MSM from four countries in West Africa (Burkina Faso, Côte d’Ivoire, Mali, and Togo) between 2015 and 2019. This study is important as it reflects several key challenges in the HIV response. In addition to the challenge of increasing access to ART among men in general, there is a need for more evidence to guide interventions to improve uptake and outcomes of ART for MSM in low-income and middle-income settings [6]. ART coverage and viral suppression among MSM in Africa remain much lower than required to achieve global targets [7]. In addition, as highlighted by an Médecins Sans Frontières report in 2016 [8], and echoed by UNAIDS [9], improvements in access to HIV treatment and care has been slower in West Africa compared with other regions. HIV-positive MSM in West Africa, therefore, represent a distinctly disadvantaged group. Rapid initiation of ART is one way to increase the number of people starting treatment by reducing losses between testing and treatment. Since 2017, the World Health Organization (WHO) recommends starting ART within 7 days of an HIV diagnosis, and suggests the possibility of starting treatment on the same day of diagnosis [10]. In 2021, WHO also recommended that ART can be started outside of a health facility [11], opening the way for same day ART start as part of community-testing approaches [12]. These guidelines also put forward a good practice statement aimed at promoting uptake of same day ART start, promoting approaches to improve uptake, treatment adherence and retention such as tailored patient education, counselling and support. The study from West Africa clearly demonstrated the benefits of this approach for MSM. Two-thirds of men (65%) who were offered treatment started within 7 days, and a quarter (24%) on the same day, reflecting a high level of acceptability among a relatively healthy population (96% were WHO Clinical Stage I and median CD4+ cell count was 398 cells/μl). In multivariate analysis, rapid initiation improved viral suppression [adjusted odds ratio (aOR) 6.96, 95% confidence interval (CI) 1.98–24.46], and there was a tendency towards improved viral suppression associated with same-day ART start in univariate analysis (OR 3.33, 95% CI 0.90–12.31) [13]. Reassuringly, rapid ART initiation and same day ART start were not associated with increased disengagement from care, a concern that has been reported by several observational studies [14]. Overall, however, a third of those starting treatment were not retained in care after 3 years of follow-up, with the majority of people disengaging within the first 12 months after start of treatment. This effect of reduced retention-in-care must be well understood to determine the value of this intervention among African MSM. Is it a negative consequence of rapid ART initiation or is it a feature of this particular demographic? Some studies have observed an increased risk of loss to care among pregnant women following rapid ART initiation, underscoring the importance of providing postinitiation follow-up and support for populations at risk of disengagement from care [14]. Other studies have reported that African MSM have worse outcomes across a number of important indicators, including increased loss to follow-up [14]. A study among HIV-positive MSM in Kenya found that, in spite of employing evidence-based supportive measures, they experienced lower virologic suppression rates compared with adults in other ART programs in Africa (including the general adult population in Kenya) [15]. Men who acquired coping self-efficacy skills, in this environment of intensive structural stigma, had better outcomes, including engagement in the health system. In a study of rapid ART initiation among men in the United States, there were no differences in loss to care comparing those receiving the intervention and those receiving standard care [16]. In addition to recommending support for retention in care, the latest WHO guidelines recommends that HIV programmes include activities to trace people who have disengaged from care and provide support for re-engagement [12]. Individuals who have simply relocated and continued care at another facility may be misclassified as being lost to care [16]. The benefits of rapid ART initiation will only be realized if people who start treatment are provided with appropriate support to remain in care over the long-term, and nonjudgementally supported to reengage in care if they need to interrupt care for whatever reason. The impact of the additional burden of the stigma of being a gay male in sub-Saharan Africa must not be underestimated. Homosexuality is criminalized in many countries in sub-Saharan Africa with penalties as severe as imprisonment and death. Beyond the extreme violation of human rights brought on by these laws, they have an adverse effect on access to care and well being of HIV-positive MSM. A recent systematic review found that African countries with the most severe antigay legislation had substantially reduced rates of HIV testing among MSM compared with countries with less severe legislation (e.g. testing in the last 12 months, 35.5 vs. 49.3%, P = 0.01) [7]. The types of co-infections that may be present at the time of ART initiation can determine which antiretrovirals are used, the dosage, as well as the timing for starting ART. Currently, most people are started on a dolutegravir-based first-line regimen; if rifampicin is also being administered for tuberculosis (TB) treatment, the dosage should be raised to 50 mg twice daily [12]. Unlike efavirenz, dolutegravir is active against HIV-2, which is common in West Africa. The key contra-indication for rapid ART start is when cryptococcal meningitis is diagnosed; in such individuals, ART initiation should be deferred 4–6 weeks from the initiation of antifungal treatment [17] People with advanced HIV disease should be given priority for initiating ART as they are at higher risk of death. They should be evaluated for the risk or presence of TB and cryptococcal meningitis for which point-of-care diagnostic tests exist [12]. Individuals with pretreatment drug resistance, which may occur in greater than 10% of individuals starting ART in some countries in sub-Saharan Africa [18], are more likely to experience virologic failure. This again favours initiating with dolutegravir-containing regimens in resource-limited settings where baseline drug resistance testing is currently not recommended prior to starting ART. Point-of-care genotypic resistance tests may make resistance testing more widely available but the role of such tests in a public health approach to ART delivery remains to be determined [19]. In conclusion, rapid ART initiation is operationally feasible in African MSM and may have an important role in controlling the epidemic. Additional resources are needed to ensure sustainable benefit for this vulnerable group. Acknowledgements Conflicts of interest There are no conflicts of interest.

Timely initiation of antenatal care (ANC) is an important component of ANC services that improve the health of the mother and the newborn. Mothers who begin attending ANC in a timely manner, can fully benefit from preventive and curative services. However, evidence in sub-Saharan Africa (sSA) indicated that the majority of pregnant mothers did not start their first visit timely. As our search concerned, there is no study that incorporates a large number of sub-Saharan Africa countries. Thus, the objective of this study was to assess the prevalence of timely initiation of ANC and its associated factors in 36 sSA countries. The Demographic and Health Survey (DHS) of 36 sSA countries were used for the analysis. The total weighted sample of 233,349 women aged 15-49 years who gave birth in the five years preceding the survey and who had ANC visit for their last child were included. A multi-level logistic regression model was used to examine the individual and community-level factors that influence the timely initiation of ANC. Results were presented using adjusted odds ratio (AOR) with 95% confidence interval (CI). In this study, overall timely initiation of ANC visit was 38.0% (95% CI: 37.8-38.2), ranging from 14.5% in Mozambique to 68.6% in Liberia. In the final multilevel logistic regression model:- women with secondary education (AOR = 1.08; 95% CI: 1.06, 1.11), higher education (AOR = 1.43; 95% CI: 1.36, 1.51), women aged 25-34 years (AOR = 1.20; 95% CI: 1.17, 1.23), ≥35 years (AOR = 1.30; 95% CI: 1.26, 1.35), women from richest household (AOR = 1.19; 95% CI: 1.14, 1.22), women perceiving distance from the health facility as not a big problem (AOR = 1.05; 95%CI: 1.03, 1.07), women exposed to media (AOR = 1.29; 95%CI: 1.26, 1.32), women living in communities with medium percentage of literacy (AOR = 1.51; 95%CI: 1.40, 1.63), and women living in communities with high percentage of literacy (AOR = 1.56; 95%CI: 1.38, 1.76) were more likely to initiate ANC timely. However, women who wanted their pregnancy later (AOR = 0.84; 95%CI: 0.82, 0.86), wanted no more pregnancy (AOR = 0.80; 95%CI: 0.77, 0.83), and women residing in the rural area (AOR = 0.90; 95%CI: 0.87, 0.92) were less likely to initiate ANC timely. Even though the WHO recommends all women initiate ANC within 12 weeks of gestation, sSA recorded a low overall prevalence of timely initiation of ANC. Maternal education, pregnancy intention, residence, age, wealth status, media exposure, distance from health facility, and community-level literacy were significantly associated with timely initiation of ANC. Therefore, intervention efforts should focus on the identified factors in order to improve timely initiation of ANC in sSA. This can be done through the providing information and education to the community on the timing and importance of attending antenatal care and family planning to prevent unwanted pregnancy, especially in rural settings.

BackgroundTimely initiation of antenatal care (ANC) is an important component of ANC services that improve the health of the mother and the newborn. Mothers who begin attending ANC in a timely manner, can fully benefit from preventive and curative services. However, evidence in sub-Saharan Africa (sSA) indicated that the majority of pregnant mothers did not start their first visit timely. As our search concerned, there is no study that incorporates a large number of sub-Saharan Africa countries. Thus, the objective of this study was to assess the prevalence of timely initiation of ANC and its associated factors in 36 sSA countries.MethodsThe Demographic and Health Survey (DHS) of 36 sSA countries were used for the analysis. The total weighted sample of 233,349 women aged 15–49 years who gave birth in the five years preceding the survey and who had ANC visit for their last child were included. A multi-level logistic regression model was used to examine the individual and community-level factors that influence the timely initiation of ANC. Results were presented using adjusted odds ratio (AOR) with 95% confidence interval (CI).ResultsIn this study, overall timely initiation of ANC visit was 38.0% (95% CI: 37.8–38.2), ranging from 14.5% in Mozambique to 68.6% in Liberia. In the final multilevel logistic regression model:- women with secondary education (AOR = 1.08; 95% CI: 1.06, 1.11), higher education (AOR = 1.43; 95% CI: 1.36, 1.51), women aged 25–34 years (AOR = 1.20; 95% CI: 1.17, 1.23), ≥35 years (AOR = 1.30; 95% CI: 1.26, 1.35), women from richest household (AOR = 1.19; 95% CI: 1.14, 1.22), women perceiving distance from the health facility as not a big problem (AOR = 1.05; 95%CI: 1.03, 1.07), women exposed to media (AOR = 1.29; 95%CI: 1.26, 1.32), women living in communities with medium percentage of literacy (AOR = 1.51; 95%CI: 1.40, 1.63), and women living in communities with high percentage of literacy (AOR = 1.56; 95%CI: 1.38, 1.76) were more likely to initiate ANC timely. However, women who wanted their pregnancy later (AOR = 0.84; 95%CI: 0.82, 0.86), wanted no more pregnancy (AOR = 0.80; 95%CI: 0.77, 0.83), and women residing in the rural area (AOR = 0.90; 95%CI: 0.87, 0.92) were less likely to initiate ANC timely.ConclusionEven though the WHO recommends all women initiate ANC within 12 weeks of gestation, sSA recorded a low overall prevalence of timely initiation of ANC. Maternal education, pregnancy intention, residence, age, wealth status, media exposure, distance from health facility, and community-level literacy were significantly associated with timely initiation of ANC. Therefore, intervention efforts should focus on the identified factors in order to improve timely initiation of ANC in sSA. This can be done through the providing information and education to the community on the timing and importance of attending antenatal care and family planning to prevent unwanted pregnancy, especially in rural settings.

To identify mortality trends and risk factors associated with stillbirths and neonatal deaths 1982-2011. Population-based cross-sectional study based on reported pregnancy history in Iganga-Mayuge Health and Demographic Surveillance Site (HDSS) in Uganda. A pregnancy history survey was conducted among women aged 15-49 years living in the HDSS during May-July 2011 (n = 10 540). Time trends were analysed with cubic splines and linear regression. Potential risk factors were examined with multilevel logistic regression with adjusted odds ratios (AOR) and 95% confidence intervals (CI). 34 073 births from 1982 to 2011 were analysed. The annual rate of decrease was 0.9% for stillbirths and 1.8% for neonatal mortality. Stillbirths were associated with several risk factors: multiple births (AOR 2.57, CI 1.66-3.99), previous adverse outcome (AOR 6.16, CI 4.26-8.88) and grand multiparity among 35- to 49-year-olds (AOR 1.97, CI 1.32-2.89). Neonatal deaths were associated with multiple births (AOR 6.16, CI 4.80-7.92) and advanced maternal age linked with parity of 1-4 (AOR 2.34, CI 1.28-4.25) and grand multiparity (AOR 1.44, CI 1.09-1.90). Education, marital status and household wealth were not associated with the outcomes. The slow decline in mortality rates and easily identifiable risk factors calls for improving quality of care at birth and a rethinking of how to address obstetric risks, potentially a revival of the risk approach in antenatal care.

Associations between women's perceptions of domestic violence and contraceptive use in seven countries in West and Central Africa

COVID-19 infection survivors and the risk of depression and anxiety symptoms: A nationwide study of adults in the United States

Ghana is a developing country in West Africa with a population of about 25 million. Medical illnesses in Ghana overlap with those in developed countries, but infection, trauma, and women’s health problems are much more prominent. Medical practice in rural Africa faces extremely limited resources, a multiplicity of languages (hundreds in Ghana), and presentation of severe illnesses at later stages than seen elsewhere. Despite these limitations, Ghana has established a relatively successful national medical insurance system, and the quality of medical practice is high, at least where it is available. Ghana also has a well-established and sophisticated administrative structure for the supervision of medical education and accreditation, but it has proven very difficult to extend medical training to rural areas, where health care facilities are particularly short of personnel. Physicians are sorely needed in rural areas, but there are few because of the working conditions and financial limitations. Hospital wards and clinics are crowded; time per patient is limited. This article details some of the differences between medical practice in Ghana and that in wealthier countries and how it functions with very limited resources. It also introduces the medical education and training system in Ghana. The following article describes an attempt to establish and maintain a residency training program in General Medicine in a rural area of Ghana.

BackgroundOn March 23, 2014, the World Health Organization (WHO) was notified of an outbreak of Ebola virus disease (EVD) in Guinea. On August 8, the WHO declared the epidemic to be a “public health emergency of international concern.”MethodsBy September 14, 2014, a total of 4507 probable and confirmed cases, including 2296 deaths from EVD (Zaire species) had been reported from five countries in West Africa — Guinea, Liberia, Nigeria, Senegal, and Sierra Leone. We analyzed a detailed subset of data on 3343 confirmed and 667 probable Ebola cases collected in Guinea, Liberia, Nigeria, and Sierra Leone as of September 14.ResultsThe majority of patients are 15 to 44 years of age (49.9% male), and we estimate that the case fatality rate is 70.8% (95% confidence interval [CI], 69 to 73) among persons with known clinical outcome of infection. The course of infection, including signs and symptoms, incubation period (11.4 days), and serial interval (15.3 days), is similar to that reported in previous outbreaks of EVD. On the basis of the initial periods of exponential growth, the estimated basic reproduction numbers (R0) are 1.71 (95% CI, 1.44 to 2.01) for Guinea, 1.83 (95% CI, 1.72 to 1.94) for Liberia, and 2.02 (95% CI, 1.79 to 2.26) for Sierra Leone. The estimated current reproduction numbers (R) are 1.81 (95% CI, 1.60 to 2.03) for Guinea, 1.51 (95% CI, 1.41 to 1.60) for Liberia, and 1.38 (95% CI, 1.27 to 1.51) for Sierra Leone; the corresponding doubling times are 15.7 days (95% CI, 12.9 to 20.3) for Guinea, 23.6 days (95% CI, 20.2 to 28.2) for Liberia, and 30.2 days (95% CI, 23.6 to 42.3) for Sierra Leone. Assuming no change in the control measures for this epidemic, by November 2, 2014, the cumulative reported numbers of confirmed and probable cases are predicted to be 5740 in Guinea, 9890 in Liberia, and 5000 in Sierra Leone, exceeding 20,000 in total.ConclusionsThese data indicate that without drastic improvements in control measures, the numbers of cases of and deaths from EVD are expected to continue increasing from hundreds to thousands per week in the coming months.

An estimated seven million people per year die from emission-related diseases. These include stroke and heart disease, respiratory illness and cancers. Many health-harmful emission pollutants also damage the climate and reducing emission pollution would save lives and help slow the pace of near-term climate change. This study investigated the environmental quality and its attendant effect on human health from Anglophone countries in West Africa over the period of 1990 to 2013 using panel quantile regression. The result obtained showed that the CO2 emission that can affect the health of Anglophone countries in West Africa are CO2 emissions from gaseous fuel consumption, CO2 emissions from liquid fuel consumption, CO2 emissions from residential buildings and commercial and public services, CO2 emissions from solid fuel consumption, CO2 emissions from transport. Other control variables that have influence on human health were health expenditure, mortality rate and fertility rate. Therefore, the policy makers should implement policies (like energy conservation policies) that will control emission from gaseous fuel consumption, emissions from liquid fuel consumption, emissions from residential buildings and commercial and public services, emissions from solid fuel consumption and emissions from transport. Also, health sector has to be properly cater for by spending more on health and this can only increase the health outcomes in a country.

BackgroundChildren with disabilities have been low on the agenda of child health, including in Sierra Leone, and there are still many gaps in our knowledge and understanding of the issue. ObjectiveTo estimate the prevalence of children with disabilities in Sierra Leone using functional difficulty as a proxy and to understand the factors associated with disabilities among children two to four years living in Sierra Leone. MethodsWe used cross-sectional data from the Sierra Leone 2017 Multiple Indicator Cluster Survey. Disability was defined using a functional difficulty definition with additional thresholds used to define children with severe functional difficulty and multiple disabilities. Logistic regression models estimated odds ratios (ORs) of childhood disability and how they were associated with socioeconomic factors and living conditions. ResultsPrevalence of children with disabilities was 6.6% (95% confidence interval (CI) 5.8–7.6%) and there was a high risk of comorbidity between different functional difficulties. Children with disabilities were less likely to be girls (adjusted odds ratio (AOR) 0.8 (CI 0.7–1.0) and older (AOR 0.3 (CI 0.2–0.4)), but more prone to be stunted (AOR 1.4 (CI 1.1–1.7)) and have younger caregivers (AOR 1.3 (CI 0.7–2.3)). ConclusionThe prevalence of disabilities in young Sierra Leonean children was comparable to other countries in West and Central Africa when using the same measure of disability. Preventive as well as early detection and intervention efforts are recommended to be integrated with other programs, e.g vaccinations, nutrition, and poverty reducing programs.

The Cholera-Hospital-Based-Intervention-for-7-days (CHoBI7) is a water treatment and handwashing with soap intervention for diarrhoea patients and their household members which is initially delivered in a healthcare facility setting. This study evaluated the effectiveness of CHoBI7 program delivery in increasing handwashing with soap in a healthcare facility setting among diarrhoea patients and their household members. A randomised controlled trial of the CHoBI7 program was conducted among 404 diarrhoea patients and their accompanying household members in healthcare facilities in Dhaka, Bangladesh. The 'Standard Message' Arm received the standard message given in Bangladesh to diarrhoea patients on the use of oral rehydration solution. The 'Health Facility Visit+Soapy Water' Arm received the standard message, the CHoBI7 communication module delivered bedside to the patient; and a soapy water bottle in the healthcare facility. The 'Health Facility Visit+Handwashing Station' Arm received this same intervention plus a small plastic handwashing station. Within 24h of intervention delivery, three-hour structured observation of handwashing practices at stool/vomit- and food-related events (key events) was conducted in healthcare facilities of diarrhoea patients and their accompanying household members. Compared to the Standard Message Arm, there was significantly more handwashing with soap at key events in both the Health Facility Visit + Soapy Water Arm (51% vs. 25 %) (Odds Ratio: 3.02; (95% Confidence Interval (CI): 1.41, 6.45) and the Health Facility Visit+Handwashing Station Arm (58% vs. 25%) OR: 4.12; (95% CI: 1.86, 9.14). These findings demonstrate that delivery of the CHoBI7 communication module and provision of a soapy water bottle to diarrhoea patients and their accompanying household members presents a promising approach to increase handwashing with soap among this high risk population in a healthcare facility setting in Bangladesh.

Background In Senegal, many interventions have been carried out in the fight against malaria. Thus, the prevalence of malaria has clearly declined from 2010 to the present day. The objective of this study is to study the factors associated with malaria. Methods Senegal is a country in West Africa. The analyses in this study were based on DHS data from 2010 to 2017 from Senegal. Data from 5 DHS surveys were used (2010-2011, 2012-2013, 2014, 2015, 2016). Malaria prevalence had been studied on the basis of RDT positivity. A multivariate analysis with an adjustment over the years was done. The variables studied were socio-demographic characteristics such as age, socioeconomic level and dwelling place (rural vs. urban), variables related to the type of habitat and the use of mosquito nets. The analyses were done using STATA.15. Results The results showed a reduction in malaria prevalence from 3.01% to 0.8% from 2010 to 2016. The protective factors are belonging to a well-off socio-economic background (middle OR:046 [0.24-0.90], richer OR = 0.37 [0.15-0.93]). The other factors associated with malaria are the fact of living in rural area (OR: 1.7 [1.06-2.89]). Conclusions Despite the decline in malaria prevalence over the years in Senegal, its persistence could be feared if factors related to the socio-economic level are not addressed. Key messages Special attention must be paid to people living in rural areas as part of the fight against malaria. The fight against malaria will necessarily involve the fight for the socio-economic emergence of countries in West Africa.