Abstract
.Distribution of long-lasting insecticide-treated nets (LLINs), passive detection and treatment with artemisinin-based combination therapy (ACT), and intermittent preventive treatment in pregnancy (IPTp) are the mainstay malaria control measures of Guinea-Bissau’s national control programme. This study aimed to estimate the prevalence of Plasmodium falciparum on Bubaque, the most populous island of the country’s remote Bijagos archipelago. A cross-sectional survey was performed at the start of the rainy season in August 2017. Participants were recruited using systematic random sampling in a two-stage stratified cluster design. Malaria parasitemia was detected using rapid diagnostic tests (RDTs) and quantitative PCR (qPCR). Data on housing, education, larval source management, socioeconomic status, anemia, and malaria preventive measures were collected. Multivariable logistic regression models were constructed to identify associations with P. falciparum infection. Four hundred four persons (aged 6 months–79 years, median 17 years) were enrolled in the study. The prevalence of P. falciparum parasitemia was 5.8% by RDT (95% CI: 3.55–9.33) and 16.9% by qPCR (95% CI: 13.09–21.71). The prevalence of anemia was 74.3% (95% CI: 69.04–78.85) as defined by the WHO criteria. All sampled houses were found to have open eaves; 99.5% of the surveyed population reported sleeping under a bednet (95% CI: 97.8–99.9). Although reported LLIN use is high, there remains an appreciable prevalence of malaria, suggesting that transmission is ongoing and further tools are required to reduce the burden of the disease.
Highlights
In 2016, the West African subregion had the highest number of cases of malaria due to Plasmodium falciparum, with an estimated 111 million cases.[1]
The most educated person in each household had on average 7.7 years of formal schooling (Supplemental Table 3); 48.3% of households had a female person as their most educated member; such households had a similar proportion of P. falciparum cases as households in which the most educated person was male (P = 0.99)
Women were more likely to be anemic than men, according to the WHO age-adjusted criteria, with an average of 107 g/dL versus 113 g/dL, respectively (P = 0.0006)
Summary
In 2016, the West African subregion had the highest number of cases of malaria due to Plasmodium falciparum, with an estimated 111 million cases.[1] Within the subregion, GuineaBissau reported an estimated 132,600 cases and 600 deaths from malaria that year. Snounou et al.’s seminal 1993 study was an early PCR-based malaria survey during the rainy season in the village of Bor, west of Bissau, the country’s capital city. Of 79 asymptomatic persons (all ages) surveyed, 69 persons were reportedly infected with Plasmodium species, including 49 with P. falciparum, a positivity rate of 87%. A study by Santoguina et al.[2] in 2009 of 2,348 asymptomatic persons (all ages) at three sites in the Gambia and Guinea-Bissau (West of Bissau), respectively, found an overall parasite prevalence of 25.5% (95% CIs: 23.7–27.3%). All three sites had comparable prevalence of P. falciparum infections
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