Abstract
BackgroundAlthough the burden of malaria has significantly declined in recent years in sub-Saharan Africa through the widespread use of long-lasting insecticide treated bed-nets (LLINs) and artemisinin-based combination therapy, resurgence of malaria is observed in some settings after several years of LLINs use. This study aimed to assess if LLINs use remains protective against malaria during a period of resurgence of malaria morbidity in Dielmo, a rural village of Senegal.MethodsIn July 2008, LLINs were offered to all villagers and lately in July 2011, LLINs were renewed.A longitudinal study was conducted between July, 2010 and December, 2011 among inhabitants of the village of Dielmo to identify all episodes of fever. Thick smears stained with Giemsa were done for every febrile villager and malaria attacks were treated with combination of Artesunate plus Amodiaquine. Cross-sectional surveys were also conducted at the end of the rainy season (October 2010 and November 2011) to assess asymptomatic carriage. A survey on LLINs use was done every quarter of the year. A random-effect logistic regression was used to assess the effect of LLINs use on the risk of having a malaria attack after adjusting for the main risk factors.ResultsThe study population included 449 individuals corresponding to a total of 2140 observations. One hundred and fifteen (115) clinical malaria attacks attributed to P. falciparum (cases) have been recorded over the study period. Most of the malaria cases occurred in October-December 2010 (49/115 i.e. 43%) and among adults aged 15 years and over (50/115, i.e. 43%). During the study period, the use of LLINs was 61% among non-malaria cases and only 42% among malaria clinical cases but differenced according to age group.After adjusting on gender, age, rainfall and LLINs replacement, we found that LLINs use (AOR [95%CI] = 0.40 [0.25; 0.62], p < 0.001) remained a protective factor against malaria attacks during the study period.ConclusionLLINs use remains effective to reduce malaria burden. These results highlight the need to pursue LLINs implementation in the current context of malaria elimination and to provide positive incentives to increase its use in the population.
Highlights
The burden of malaria has significantly declined in recent years in sub-Saharan Africa through the widespread use of long-lasting insecticide treated bed-nets (LLINs) and artemisinin-based combination therapy, resurgence of malaria is observed in some settings after several years of LLINs use
Among the 2186 observations, we excluded 3 observations among malaria cases because they were not investigated for LLINs surveys and another 43 which were related to pregnant women
The aim of this study was to explore the specific role of LLINs use on malaria resurgence that occurred in Dielmo in late 2010 and 2011
Summary
The burden of malaria has significantly declined in recent years in sub-Saharan Africa through the widespread use of long-lasting insecticide treated bed-nets (LLINs) and artemisinin-based combination therapy, resurgence of malaria is observed in some settings after several years of LLINs use. This study aimed to assess if LLINs use remains protective against malaria during a period of resurgence of malaria morbidity in Dielmo, a rural village of Senegal. A subsequent decline of malaria morbidity and mortality has been achieved in recent years in sub-Saharan Africa through the widespread use of artemisinin-based combination therapy (ACT) and long-lasting insecticidetreated nets (LLINs) [1,2,3,4]. A study conducted between 2002 and 2010 after the introduction of LLINs in three sentinel sites in Kenya showed that malaria prevalence significantly decreased between 2002 and 2006 but increased in two of the three sites in 2010 [11]
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