West African Setting Research Articles

SPEEK: effect evaluation of a Ghanaian school-based and peer-led sexual education programme.

In sub-Saharan Africa, theory and evidenced-based interventions that are systematically designed and using sound evaluation methods to report on effectiveness are limited. A sex education programme called SPEEK was developed, implemented and evaluated in Ghana using the Intervention Mapping approach. SPEEK aimed at delaying sexual initiation, reducing sexually transmitted infections (STIs) and preventing pregnancy, targeting junior high school students in a West African rural setting. The final programme included 11 (interactive) lessons using a diverse range of theory-based methods. In this article, we report on the effect evaluation of the programme. Participating schools were randomized to the intervention (N = 10 schools) and a waiting-list control group (N = 11 schools). The students completed survey questionnaires at baseline (N = 1822), at direct post-test (N = 1805) and at six months follow-up (N = 1959), measuring cognitive and affective psychosocial determinants of sexual delay, condom use and STI testing. Mixed regression models showed that at direct post-test, students having received the SPEEK programme scored significantly more positively on knowledge on condom use, pregnancy and STIs testing; attitude toward exercising sexual rights, condom availability and condom use; perceived behavioural control toward sexual delay, condom use and sexual intercourse; and perceived risk toward STIs (P's < 0.002). The results suggest that the programme may improve adolescent sexual health in Ghana or in similar cultures, but would need further study that include behavioural measures and a longer follow-up to make this assertion with more confidence.

Community knowledge, attitudes and practices related to schistosomiasis and associated healthcare-seeking behaviours in northern C\xf4te d\u2019Ivoire and southern Mauritania

BackgroundAmong parasitic infections, schistosomiasis ranks second after malaria in terms of worldwide morbidity. Despite efforts to contain transmission, more than 230 million people are infected, of which 85% live in Sub-Saharan Africa. While the epidemiologic characteristics of schistosomiasis have been extensively studied across endemic settings, social factors have been paid less attention. The current study assesses community knowledge of schistosomiasis causes, transmission, signs, symptoms and prevention, as well as healthcare-seeking behaviours in two West African settings, with the aim of strengthening schistosomiasis control interventions.MethodsFrom August 2014 to June 2015, we conducted two cross-sectional surveys in Korhogo, Côte d’Ivoire and Kaédi, Mauritania. We applied a questionnaire to collect quantitative data at the household level in Korhogo (n = 1456) and Kaédi (n = 1453). Focus group discussions (Korhogo: n = 32, Kaédi: n = 32) and participatory photography (photovoice) (Korhogo: n = 16, Kaédi: n = 16) were conducted within the communities to gather qualitative data. In addition, semi-structured interviews were used to discuss with key informants from control programmes, non-governmental organizations and health districts (Korhogo: n = 8, Kaédi: n = 7).ResultsThe study demonstrated that schistosomiasis is not well known by the communities; 64.1% claimed to know the causes of the disease, but the reality is different. This knowledge is more from cultural than biomedical source. It was observed that social construction of the disease is different from the biomedical definition. In Korhogo, schistosomiasis was often associated with several other diseases, notably stomach ulcer and gonorrhoea. The populations believe that schistosomiasis is caused by exposure to goat or dog urine in the environment. In Kaédi, schistosomiasis is considered as a disease transmitted by environmenal elements such as sunshine and dirty water. In both settings, the care-seeking pathways were found to be strongly influenced by local customs and self-medication acquired from the informal sector.ConclusionsThis study revealed that knowledge about the aetiology, transmission, symptoms, prevention and treatment of schistosomiasis among the populations in Korhogo and Kaédi is based on their local culture. Deep-rooted habits could therefore pose a significant obstacle to the elimination of schistosomiasis.

Transmission of molecularly undetectable circulating parasite clones leads to high infection complexity in mosquitoes post feeding

Plasmodium falciparum malaria infections often comprise multiple distinct parasite clones. Few datasets have directly assessed infection complexity in humans and mosquitoes they infect. Examining parasites using molecular tools may provide insights into the selective transmissibility of isolates. Using capillary electrophoresis genotyping and next generation amplicon sequencing, we analysed complexity of parasite infections in human blood and in the midguts of mosquitoes that became infected in membrane feeding experiments using the same blood material in two West African settings. Median numbers of clones in humans and mosquitoes were higher in samples from Burkina Faso (4.5, interquartile range 2–8 for humans; and 2, interquartile range 1–3 for mosquitoes) than in The Gambia (2, interquartile range 1–3 and 1, interquartile range 1–3, for humans and mosquitoes, respectively). Whilst the median number of clones was commonly higher in human blood samples, not all transmitted alleles were detectable in the human peripheral blood. In both study sample sets, additional parasite alleles were identified in mosquitoes compared with the matched human samples (10–88.9% of all clones/feeding assay, n = 73 feeding assays). The results are likely due to preferential amplification of the most abundant clones in peripheral blood but confirm the presence of low density clones that produce transmissible sexual stage parasites.

Surviving loss and remaking the world: Reflections on the singular universal in a West African setting

As an ethnographer, I am obliged to reflect on the philosophical implications of my work to the same extent that I assume that any productive engagement with the human condition necessarily involve...

Enhanced case management can be delivered for patients with EVD in Africa: Experience from a UK military Ebola treatment centre in Sierra Leone

BackgroundLimited data exist describing supportive care management, laboratory abnormalities and outcomes in patients with Ebola virus disease (EVD) in West Africa. We report data which constitute the first description of the provision of enhanced EVD case management protocols in a West African setting. MethodsDemographic, clinical and laboratory data were collected by retrospective review of clinical and laboratory records of patients with confirmed EVD admitted between 5 November 2014 and 30 June 2015. ResultsA total of 44 EVD patients were admitted (median age 37 years (range 17–63), 32/44 healthcare workers), and excluding those evacuated, the case fatality rate was 49% (95% CI 33%–65%). No pregnant women were admitted. At admission 9/44 had stage 1 disease (fever and constitutional symptoms only), 12/44 had stage 2 disease (presence of diarrhoea and/or vomiting) and 23/44 had stage 3 disease (presence of diarrhoea and/or vomiting with organ failure), with case fatality rates of 11% (95% CI 1%–58%), 27% (95% CI 6%–61%), and 70% (95% CI 47%–87%) respectively (p = 0.009). Haemorrhage occurred in 17/41 (41%) patients. The majority (21/40) of patients had hypokalaemia with hyperkalaemia occurring in 12/40 patients. Acute kidney injury (AKI) occurred in 20/40 patients, with 14/20 (70%, 95% CI 46%–88%) dying, compared to 5/20 (25%, 95% CI 9%–49%) dying who did not have AKI (p = 0.01). Ebola virus (EBOV) PCR cycle threshold value at baseline was mean 20.3 (SD 4.3) in fatal cases and 24.8 (SD 5.5) in survivors (p = 0.007). Mean national early warning score (NEWS) at admission was 5.5 (SD 4.4) in fatal cases and 3.0 (SD 1.9) in survivors (p = 0.02). Central venous catheters were placed in 37/41 patients and intravenous fluid administered to 40/41 patients (median duration of 5 days). Faecal management systems were inserted in 21/41 patients, urinary catheters placed in 27/41 and blood component therapy administered to 20/41 patients. ConclusionsEVD is commonly associated life-threatening electrolyte imbalance and organ dysfunction. We believe that the enhanced levels of protocolized care, scale and range of medical interventions we report, offer a blueprint for the future management of EVD in resource-limited settings.

Ambulatory monitoring demonstrates an acute association between cookstove-related carbon monoxide and blood pressure in a Ghanaian cohort

BackgroundRepeated exposure to household air pollution may intermittently raise blood pressure (BP) and affect cardiovascular outcomes. We investigated whether hourly carbon monoxide (CO) exposures were associated with acute increases in ambulatory blood pressure (ABP); and secondarily, if switching to an improved cookstove was associated with BP changes. We also evaluated the feasibility of using 24-h ambulatory blood pressure monitoring (ABPM) in a cohort of pregnant women in Ghana.MethodsParticipants were 44 women enrolled in the Ghana Randomized Air Pollution and Health Study (GRAPHS). For 27 of the women, BP was measured using 24-h ABPM; home blood pressure monitoring (HBPM) was used to measure BP in the remaining 17 women. Personal CO exposure monitoring was conducted alongside the BP monitoring.ResultsABPM revealed that peak CO exposure (defined as ≥4.1 ppm) in the 2 hours prior to BP measurement was associated with elevations in hourly systolic BP (4.3 mmHg [95% CI: 1.1, 7.4]) and diastolic BP (4.5 mmHg [95% CI: 1.9, 7.2]), as compared to BP following lower CO exposures. Women receiving improved cookstoves had lower post-intervention SBP (within-subject change in SBP of −2.1 mmHg [95% CI: -6.6, 2.4] as compared to control), though this result did not reach statistical significance. 98.1% of expected 24-h ABPM sessions were successfully completed, with 92.5% of them valid according to internationally defined criteria.ConclusionsWe demonstrate an association between acute exposure to carbon monoxide and transient increases in BP in a West African setting. ABPM shows promise as an outcome measure for assessing cardiovascular health benefits of cookstove interventions.Trial registrationThe GRAPHS trial was registered with clinicaltrials.gov on 13 April 2011 with the identifier NCT01335490.

Temporal analysis of IgG antibody responses to Plasmodium falciparum antigens in relation to changing malaria epidemiology in a West African setting

BackgroundCoordinated scaled-up malaria control interventions have substantially contributed to the dramatic decrease of malaria-related morbidity and mortality in several endemic countries, including Senegal. However, the impacts of a given malaria control intervention on vector and parasite populations, acquired immunity, and disease burden remain very poorly documented largely due to the lack of continuous surveys. This study took advantage of the sera bank established as part of the Dielmo longitudinal project to investigate the dynamics of IgG antibody responses that accompanied the epidemiological changes resulting from malaria control interventions. Schizonts crude extract of a local strain of Plasmodium falciparum (Pfsch07/03) was used in ELISA to measure and compare seroprevalence and magnitude of IgG antibody responses from 2000 to 2012.ResultsThe prevalence of Pfsch07/03 IgG antibody responses progressively decreased from 97.25% in 2000 to 57.3% in 2012. The prevalence of Pfsch07/03 antibodies categorized between three different age groups (<7, 7–15, and >15 years) revealed increased seroprevalence with age ranging from 47.19 to 62.67 and 89.45%, respectively in (<7, 7–15, and >15 years) old age groups. A marked drop in seroprevalence was observed after 2008 and was significant in the younger (<7 years) and intermediate (7–15 years) age groups, unlike older individuals aged >15 years (p = 1.00).ConclusionsThe study revealed a substantial contribution of all malaria control interventions to the decrease of IgG antibodies responses to Pfsch07/03 throughout prevention of human-mosquitos contacts, or reduction of parasite biomass. The present study demonstrates the wider potential of sero-epidemiological analysis in monitoring changes in malaria transmission resulting from a given malaria control intervention.

Facility-based surveillance for emerging infectious diseases; diagnostic practices in rural West African hospital settings: observations from Ghana.

The aim of this study was to better understand the effectiveness of Integrated Disease Surveillance and Response (IDSR) facility-based surveillance in detecting newly emerging infectious diseases (EIDs) in rural West African settings. A six-month ethnographic study was undertaken in 2012 in the Techiman Municipality of the Brong-Ahafo Region of Ghana, aimed at documenting the trajectories of febrile illness cases of unknown origin occurring within four rural communities. Particular attention was paid to where these trajectories involved the use of formal healthcare facilities and the diagnostic practices that occurred there. Seventy-six participants were enrolled in the study, and 24 complete episodes of illness were documented. While participants routinely used hospital treatment when confronted with enduring or severe illness, the diagnostic process within clinical settings meant that an unusual diagnosis, such as an EID, was unlikely to be considered. Facility-based surveillance is unlikely to be effective in detecting EIDs due to a combination of clinical care practices and the time constraints associated with individual episodes of illness, particularly in the resource-limited settings of rural West Africa, where febrile illness due to malaria is common and specific diagnostic assays are largely unavailable. The success of the ‘One Health' approach to EIDs in West Africa is predicated on characterization of accurately diagnosed disease burdens. To this end, we must address inefficiencies in the dominant approaches to EID surveillance and the weaknesses of health systems in the region generally.This article is part of the themed issue ‘One Health for a changing world: zoonoses, ecosystems and human well-being'.

Ambivalent Precarity: Career Trajectories and Temporalities in Highly Skilled Sports Labor Migration from West Africa to Northern Europe

AbstractTransnational migrants are often considered to be the core of the new global precariat. On the one hand, migrants are particularly likely to become precariats, due to the outsourcing of precarious work to migrant workers and the attribution of precarious citizenship status to migrants. On the other hand, labor migrants’ accounts show that this precarity is not exclusively based on oppression, misery, and exploitation, but that labor migration is also driven by hope and the imagination of a better future; hardships may even open up new opportunities. This article aims to scrutinize the ambivalence of precarity and the ways in which precarization processes also appear in highly skilled labor migration (in this case sought‐after jobs as transnational athletes). The article draws on material from multisited field studies among aspiring and current soccer migrants. The experiences and conditions are described for female and male soccer players who originate from various West African settings and move to Northern European locations. The analysis finds ambivalent precarization processes at various points of the career. The temporality of precarization processes becomes apparent when comparing the large number of young men and women who strive to migrate to the few individuals who become professional players abroad but often struggle with occupational challenges after their careers. The article ends by suggesting an engagement with the ambivalences of precarious work in future studies, both in sport and other vocational sectors.

Remedial after-school support classes offered in rural Gambia (The SCORE trial): study protocol for a cluster randomized controlled trial.

BackgroundLow education levels are endemic in much of the developing world, particularly in rural areas where traditional government-provided public services often have difficulty reaching beneficiaries. Providing trained para-teachers to teach regular after-school remedial education classes has been shown to improve literacy and numeracy in children of primary school age residing in such areas in India. This trial investigates whether such an intervention can also be effective in a West African setting with similarly low learning levels and difficult geographic access.Methods/DesignDesign: cluster-randomized controlled trial.Clusters: villages or groups of villages with 15–300 households and at least 15 eligible children in the Lower River and North Bank Regions of The Gambia.Participants: children born between 1 September 2007 and 31 August 2009 planning to enter the first grade, for the first time, in the 2015–2016 school year in eligible villages. We anticipate enrolling approximately 150 clusters of villages with approximately 6000 children as participants.Intervention: a program providing remedial after-school lessons, focusing on literacy and numeracy, 5 to 6 days a week for 3 years to eligible children, based on the intervention evaluated in the Support To Rural India’s Public Education System (STRIPES) trial (PLoS ONE 8(7):e65775).Control: both the intervention and control groups will receive small bundles of useful materials during annual data collection as recompense for their time. If the education intervention is shown to be cost-effective at raising learning levels, it is expected that the control group villages will receive the intervention for several years after the trial results are available.Outcomes: the primary outcome of the trial is a composite mathematics and language test score. Secondary outcomes include school attendance, enrollment, performance on nationally administered exams, parents’ spending on education, spillover learning to siblings and family members, and school-related time use of parents and children. Subgroup analyses of the primary outcome will also be carried out based on ethnic group, gender, distance from the main highway, parents’ education level, and school type.The trial will run by independent research and implementation teams and supervised by a Trial Steering Committee.DiscussionAlong with the overall impact of the intervention, we will conduct a cost-effectiveness analysis.There are no major ethical issues for this study.Trial registrationCurrent controlled trials ISRCTN12500245. 1 May 2015.

Late-life depression: Burden, severity and relationship with social support dimensions in a West African community

ObjectivesThe occurrence of depression in old age is often linked with grave consequences. The purpose of this study is to investigate the burden of depression and its relationship with perceived social support among the elderly in a West African community setting. MethodsIn this cross-sectional study, participants made up of 350 elders aged 60 years and above were selected through multi-stage random sampling technique. All participants were interviewed with designed questionnaire, multidimensional scale of perceived social support (MSPSS) and Geriatric Depression Scale (GDS) to elicit socio-demographic profile, social support and depressive psychopathology respectively. ResultsThe participants were largely females (52.9%) and their mean age was 68.8±7.3 years. A little above one-quarter (26.4%) had depressive episode, and mild severity was preponderant. Low level of social support was associated with depression (χ2=8.418, p=0.004); especially low social supports from significant others (χ2=3.989, p=0.046) and family members (χ2=4.434, p=0.035). Similarly, severity of depression in the elderly correlated negatively with availability of social support from significant others (χ2=5.495, p=0.019) and family members (χ2=5.149, p=0.023). ConclusionConsidering the burden of depression in this elderly population and the influential roles of social support especially from family and significant others on depression; strengthening of informal social support and formal social support for the elders is advocated. In addition, design of community based geriatric mental health with social services and articulation of public policy to address old age needs are implied.

Friendship and Gender in Cultural-Psychological Perspective: Implications for Research, Practice, and Consultation

Previous research documented differences in friendship such that people in various North American settings reported more friends, emphasized emotional support, and de-emphasized instrumental support relative to people in various West African settings. We used an experimental manipulation to test the hypothesis that these patterns reflect affordances for abstracted independence and embedded interdependence. Participants from universities in Ghana ( n = 67; 53% women) and the U.S.A. ( n = 71; 47% women) completed individual (“I am . . .”) or collective (“We are . . .”) versions of the Twenty Statements Test. They then completed measures of friendship experience. Results replicated cross-national differences and provided some evidence for hypothesized effects of the manipulation. Participants in the abstracted-independence condition reported “more friends than others” and (in the Ghanaian setting) emphasized emotional support over instrumental support to a greater extent than did participants in the embedded-interdependence condition. Discussion focuses on implications of international perspectives in psychology for research, practice, and consultation about relational belonging.

Beware of friends: The cultural psychology of relational mobility and cautious intimacy

Previous research has contrasted patterns of cautious or prevention‐oriented relationality in various West African settings with patterns of growth or promotion‐oriented relationality in many North American settings. The present research draws upon the concept of relational mobility to test the hypothesis that different patterns of relationality have their source in respective affordances for embedded interdependence or abstracted independence. Study 1 investigated the relationship between cautious intimacy and perception of relational mobility among a sample of Hong Kong students. Study 2 compared students in Hong Kong and North American settings to test whether differences in perception of relational mobility mediated the hypothesized differences in caution about friends. Study 3 used an experimental manipulation among a sample of Hong Kong students to test the hypothesis that increased perception of relational mobility reduces caution about friends. Results reveal broad support for the hypotheses. Whether as a measured variable or as an experimental treatment, the perception of relational mobility was negatively related to caution about friends. Moreover, this relationship mediated hypothesized cross‐national differences in caution about friendship. A discussion of the results considers intersections of cultural and ecological approaches to psychology and implications for theoretical conceptions of interdependence.

Decolonizing methods

Interdisciplinary scholarship has highlighted the coloniality of knowledge: The idea that mainstream research is an integral component of racialized modernity that reflects perspectives of the powerful and reproduces domination. To counteract the coloniality of knowledge, decolonial theorists advocate research strategies of accompaniment that draw upon local understandings as an epistemological basis for rethinking mainstream research. To illustrate these strategies, I briefly describe observations from a program of research that compares experience of relationship across diverse West African and North American settings. Qualitative methods of accompaniment help illuminate forms of marginalized knowledge that not only make visible the political economy of relationship research but also suggest directions for sustainable ways of relating that reflect and promote the interests of broad humanity.

Men's and women's experiences of violence and traumatic events in rural Côte d'Ivoire before, during and after a period of armed conflict

ObjectiveWe assessed men's and women's experiences of gender based violence and other traumatic events in Côte d'Ivoire, a West African conflict-affected setting, before, during and after a period of active...

Self and Agency in Context: Ecologies of Abundance and Scarcity

This work considers sociocultural foundations of self and agency in material affordances associated with affluence and poverty. We first review work that links independent self-construal and disjoint agency to material abundance. We then report an experiment among students at North American ( n = 52) and West African ( n = 60) universities, in which we manipulated abundance and scarcity concepts and assessed effects on a pronoun-selection measure of self-construal. Participants in the North American setting and abundance condition selected first-person pronouns (particularly, I and me) with greater frequency than did participants in the West African setting and scarcity condition. In contrast to modernity accounts, which propose that individualism promotes prosperity, results are consistent with the alternative account: that abundance can promote independent or disjoint varieties of self and agency. Discussion focuses on the distinction between cultural and structural varieties of sociocultural influence and contributions of international perspectives to psychological science.

Comparison of Electronic Data Capture (EDC) with the Standard Data Capture Method for Clinical Trial Data

BackgroundTraditionally, clinical research studies rely on collecting data with case report forms, which are subsequently entered into a database to create electronic records. Although well established, this method is time-consuming and error-prone. This study compares four electronic data capture (EDC) methods with the conventional approach with respect to duration of data capture and accuracy. It was performed in a West African setting, where clinical trials involve data collection from urban, rural and often remote locations.Methodology/Principal FindingsThree types of commonly available EDC tools were assessed in face-to-face interviews; netbook, PDA, and tablet PC. EDC performance during telephone interviews via mobile phone was evaluated as a fourth method. The Graeco Latin square study design allowed comparison of all four methods to standard paper-based recording followed by data double entry while controlling simultaneously for possible confounding factors such as interview order, interviewer and interviewee. Over a study period of three weeks the error rates decreased considerably for all EDC methods. In the last week of the study the data accuracy for the netbook (5.1%, CI95%: 3.5–7.2%) and the tablet PC (5.2%, CI95%: 3.7–7.4%) was not significantly different from the accuracy of the conventional paper-based method (3.6%, CI95%: 2.2–5.5%), but error rates for the PDA (7.9%, CI95%: 6.0–10.5%) and telephone (6.3%, CI95% 4.6–8.6%) remained significantly higher. While EDC-interviews take slightly longer, data become readily available after download, making EDC more time effective. Free text and date fields were associated with higher error rates than numerical, single select and skip fields.ConclusionsEDC solutions have the potential to produce similar data accuracy compared to paper-based methods. Given the considerable reduction in the time from data collection to database lock, EDC holds the promise to reduce research-associated costs. However, the successful implementation of EDC requires adjustment of work processes and reallocation of resources.

Paediatric road traffic injuries in urban Ghana: a population-based study

Objective/settingTo provide a population-based analysis of childhood road traffic injuries (RTI) in two communities of the greater Accra region of Ghana, with the goal of establishing an RTI incidence baseline...

The Household Food Insecurity Access Scale and an Index-Member Dietary Diversity Score Contribute Valid and Complementary Information on Household Food Insecurity in an Urban West-African Setting ,

The number of urban poor is increasing quickly in West Africa, yet food security early warning systems still do not include urban areas. One reason is the lack of appropriate and internationally agreed-upon indicators to measure urban household food insecurity. Our objective was to assess the performance of the household food insecurity access scale (HFIAS) and an index-member’s dietary diversity score (IDDS) to approximate the adequacy of urban households’ diets. A survey was performed on a random cluster sample of 1056 households in Ouagadougou, Burkina Faso. Data on HFIAS and IDDS and 2 nonconsecutive household quantitative 24-h recalls were collected twice, in June-July and in November-December 2007. Diet adequacy was assessed through the household’s mean adequacy ratio (MAR) using energy and 11 micronutrients. Structural equation modeling was used to quantify the association of each candidate indicator with the MAR and receiver-operating characteristic (ROC) analyses were performed to assess their targeting performance in predicting low or high MAR. HFIAS was negatively associated with the MAR [path coefficient (P) = −7.95 × 10−3 ± 1.45 × 10−3; P < 0.001], whereas IDDS was positively associated with it (P = 5.19 × 10−2 ± 1.27 × 10−2; P < 0.001). Areas under the ROC curves ranged from 0.585 to 0.661 for HFIAS and from 0.536 to 0.629 for IDDS. In conclusion, HFIAS and IDDS performed well in approximating adequacy of urban households’ diets. They are informative indicators about urban food insecurity, promising for evaluation and monitoring but not for household targeting given their insufficient predictive power.

Prescribing practice for malaria following introduction of artemether-lumefantrine in an urban area with declining endemicity in West Africa

BackgroundThe decline in malaria coinciding with the introduction of newer, costly anti-malarials has prompted studies into the overtreatment for malaria mostly in East Africa. The study presented here describes prescribing practices for malaria at health facilities in a West African country.MethodsCross-sectional surveys were carried out in two urban Gambian primary health facilities (PHFs) during and outside the malaria transmission season. Facilities were comparable in terms of the staffing compliment and capability to perform slide microscopy. Patients treated for malaria were enrolled after consultations and blood smears collected and read at a reference laboratory. Slide reading results from the PHFs were compared to the reference readings and the proportion of cases treated but with a negative test result at the reference laboratory was determined.ResultsSlide requests were made for 33.2% (173) of those enrolled, being more frequent in children (0-15 yrs) than adults during the wet season (p = 0.003). In the same period, requests were commoner in under-fives compared to older children (p = 0.022); however, a positive test result was 4.4 times more likely in the latter group (p = 0.010). Parasitaemia was confirmed for only 4.7% (10/215) and 12.5% (37/297) of patients in the dry and wet seasons, respectively. The negative predictive value of a PHF slide remained above 97% in both seasons.ConclusionsThe study provides evidence for considerable overtreatment for malaria in a West African setting comparable to reports from areas with similar low malaria transmission in East Africa. The data suggest that laboratory facilities may be under-used, and that adherence to negative PHF slide results could significantly reduce the degree of overtreatment. The "peak prevalence" in 5-15 year olds may reflect successful implementation of malaria control interventions in under-fives, but point out the need to extend such interventions to older children.