No evidence of decline in malaria burden from 2006 to 2013 in a rural Province of Gabon: implications for public health policy

Vanessa Assele, Gildas Ella Ndoh, Dieudonné Nkoghe, Thierry Fandeur, Vanessa Assele, Gildas Ella Ndoh, Dieudonné Nkoghe, Thierry Fandeur

Abstract

Background: The morbidity of malaria has steady declined in the urban regions of Gabon between 2000 and 2008, but caution should be exercised before generalizing this trend to the whole country because this finding has not been systematically confirmed in remote rural provinces.

Methods: We conducted a retrospective survey using data on malaria cases recorded in North Eastern Gabon between 2006 and 2013 at health facilities in Makokou. Malaria data were analyzed, and associations with annual variations and patient age were assessed.

Results: A global increase in clinical and confirmed malaria cases was observed over the study period. The rate of infection was significantly higher in children aged between 0 to 4 years than in children of 5 years and above, and in adults. Contrary to prior observations in urban and semi-urban areas of Gabon, malaria burden remained mostly unchanged or even increased in Makokou in the Ogooué-Ivindo province during these last 8 years.

Conclusions: The persistence of Plasmodium falciparum pockets of sustained malaria transmission in rural Gabon may be related to an inadequate coverage of key interventions, to poor treatment seeking behavior and/or to a decline efficacy of treatments. Our results highlight the need to better adapt malaria control strategies to local epidemiological contexts and to environmental constraints. Equitable delivery of health service to hard-to-reach populations constitutes a challenging issue for the health authorities of Gabon.

Figures

Figure 1
Figure 1
Monthly variations in the number of presumptive and confirmed malaria cases and the slide positivity rate in Makokou between 2006 and 2013.
Figure 2
Figure 2
Monthly distribution of the mean number of presumptive and confirmed episodes of malaria between 2006 and 2013 according to mean rainfall variations in Makokou from 1960 to 1990.

References

    1. Richard-Lenoble D, Kombila M, Chandenier J, Gay F, Billiault X, Nguiri C, et al. Malaria in Gabon. 2. Evaluation of the qualitative and quantitative prevalence of parasites in the total school and preschool population of the country. Bull Soc Pathol Exot. 1987;80:532.
    1. Mombo-Ngoma G, Oyakhirome S, Ord R, Gabor JJ, Greutélaers KC, Profanter K, et al. High prevalence of dhfr triple mutant and correlation with high rates of sulphadoxine-pyrimethamine treatment failures in vivo in Gabonese children. Malar J. 2011;10:123. doi: 10.1186/1475-2875-10-123.
    1. Frank M, Lehners N, Mayengue PI, Gabor J, Dal-Bianco M, Kombila DU, et al. A thirteen-year analysis of Plasmodium falciparum populations reveals high conservation of the mutant pfcrt haplotype despite the withdrawal of chloroquine from national treatment guidelines in Gabon. Malar J. 2011;10:304. doi: 10.1186/1475-2875-10-304.
    1. Bouyou-Akotet MK, Mawili-Mboumba DP, Tchantchou TDD, Kombila M. High prevalence of sulfadoxine/pyrimethamine-resistant alleles of Plasmodium falciparum isolates in pregnant women at the time of introduction of intermittent preventive treatment with sulfadoxine/pyrimethamine in Gabon. J Antimicrob Chemother. 2010;65:438–41. doi: 10.1093/jac/dkp467.
    1. Nsimba B, Guiyedi V, Mabika-Mamfoumbi M, Mourou-Mbina JR, Ngoungou E, Bouyou-Akotet M, et al. Sulphadoxine/pyrimethamine versus amodiaquine for treating uncomplicated childhood malaria in Gabon: a randomized trial to guide national policy. Malar J. 2008;7:31. doi: 10.1186/1475-2875-7-31.
    1. Oyakhirome S, Pötschke M, Schwarz NG, Dörnemann J, Laengin M, Salazar CO, et al. Artesunate-amodiaquine combination therapy for falciparum malaria in young Gabonese children. Malar J. 2007;6:29. doi: 10.1186/1475-2875-6-29.
    1. World Health Organization: World Malaria Report 2010. []
    1. Ministère de l’Economie, du Commerce, de l’Industrie et du Tourisme. Direction des Statistiques Générales, service des statistiques de production et du commerce extérieur. Annuaire statistique du Gaboon2004-2008 n°12–avril 2010.
    1. Organisation Mondiale de la Santé. Évaluation finale Quatrième Round du Fonds mondial de lutte contre le Sida, la Tuberculose et le Paludisme «Composante Paludisme» Gabon. Novembre 2008. []
    1. Bouyou-Akotet MK, Mawili-Mboumba DP, Kendjo E, Mabika-Mamfoumbi M, Ngoungou EB, Dzeing-Ella A, et al. Evidence of decline of malaria in the general hospital of Libreville, Gaboonfrom 2000 to 2008. Malar J. 2009;8:300. doi: 10.1186/1475-2875-8-300.
    1. Mawili-Mboumba DP, Bouyou Akotet MK, Kendjo E, Nzamba J, Medang MO, Mbina JR, et al. MCORU team: increase in malaria prevalence and age of at risk population in different areas of Gabon. Malar J. 2013;12:3. doi: 10.1186/1475-2875-12-3.
    1. Schippers C. Développement d’un système d’information géographique dans le cadre de la mise en place de forêts communautaires au Nord-Est du Gabon. Faculté Universitaire des Sciences Agronomiques de Gembloux. 2007.
    1. World Health Organization: World Malaria Report 2012. Malaria country profile. []
    1. Cibulskis RE, Bell D, Christophel EM, Hii J, Delacollette C, Bakyaita N, et al. Estimating trends in the burden of malaria at country level. Am J Trop Med Hyg. 2007;77:133.
    1. O’Meara WP, Mangeni JN, Steketee R, Greenwood B. Changes in the burden of malaria in sub-Saharan Africa. Lancet Infect Dis. 2010;10:545. doi: 10.1016/S1473-3099(10)70096-7.
    1. Okiro EA, Hay SI, Gikandi PW, Sharif SK, Noor AM, Peshu N, et al. The decline in paediatric malaria admissions on the coast of Kenya. Malar J. 2007;6:151. doi: 10.1186/1475-2875-6-151.
    1. Okiro EA, Alegana VA, Noor AM, Mutheu JJ, Juma E, Snow RW. Malaria paediatric hospitalisation between 1999 and 2008 across Kenya. BMC Med. 2009;7:75. doi: 10.1186/1741-7015-7-75.
    1. Ceesay SJ, Casals-Pascual C, Erskine J, Anya SE, Duah NO, Fulford AJ, et al. Changes in malaria indices between 1999 and 2007 in The Gambia: a retrospective analysis. Lancet. 2008;372(9649):1545. doi: 10.1016/S0140-6736(08)61654-2.
    1. Barnes KI, Chanda P, Ab Barnabas G. Impact of the large-scale deployment of artemether/lumefantrine on the malaria disease burden in Africa: case studies of South Africa, Zambia and Ethiopia. Malar J. 2009;8(Suppl 1):S8. doi: 10.1186/1475-2875-8-S1-S8.
    1. Mmbando BP, Vestergaard LS, Kitua AY, Lemnge MM, Theander TG, Lusingu JP. A progressive declining in the burden of malaria in north-eastern Tanzania. Malar J. 2010;9:216. doi: 10.1186/1475-2875-9-216.
    1. Bhattarai A, Ali AS, Kachur SP, Mårtensson A, Abbas AK, Khatib R, et al. Impact of artemisinin-based combination therapy and insecticide-treated nets on malaria burden in Zanzibar. PLoS Med. 2007;4(11):e309. doi: 10.1371/journal.pmed.0040309.
    1. Otten M, Aregawi M, Were W, Karema C, Medin A, Bekele W, et al. Initial evidence of reduction of malaria cases and deaths in Rwanda and Ethiopia due to rapid scale-up of malaria prevention and treatment. Malar J. 2009;8:14. doi: 10.1186/1475-2875-8-14.
    1. World Health Organization . World Malaria Report. 2011.
    1. Mabiala-Babela JR, Samba-Louaka C, Mouko A, Senga P. Morbidity in a paediatric department (University Hospital of Brazzaville): 12 years later (1989–2001) Arch Pediatr. 2003;10:650. doi: 10.1016/S0929-693X(03)00290-2.
    1. Kimbi HK, Nformi D, Patchong AM, Ndamukong KJ. Influence of urbanisation on asymptomatic malaria in school children in Molyko, South West Cameroon. East Afr Med J. 2006;83:602.
    1. Lekana-Douki JB, Pontarollo J, Zatra R, Toure-Ndouo FS. Malaria in Gabon: results of a clinical and laboratory study at the Chinese-Gabonese Friendship Hospital of Franceville. Sante. 2011;21:193.
    1. Bouyou-Akotet MK, Nzenze-Afène S, Mawili-Mboumba DP, Owono-Medang M, Guiyedi V, Kombila M. Trends in the prevalence of malaria and anemia at delivery in Libreville from 1995 to 2011. Sante. 2011;21:199.
    1. Organisation mondiale de la Santé . Bureau pays pour le Gaboon: Rapport d’évaluation de la cinquième série du fonds mondial de lutte contre le sida, la tuberculose, le paludisme, composante paludisme, projet : faire reculer le paludisme au Gabon. 2012.
    1. Nkoghe D, Akue JP, Gonzalez JP, Leroy EM. Prevalence of Plasmodium falciparum infection in asymptomatic rural Gabonese populations. Malar J. 2011;10:33. doi: 10.1186/1475-2875-10-33.
    1. Ntoumi F, Vouvoungui JC, Ibara R, Landry M, Sidibé A. Malaria burden and case management in the Republic of Congo: limited use and application of rapid diagnostic tests results. BMC Public Health. 2013;13:135. doi: 10.1186/1471-2458-13-135.
    1. Njau JD, Stephenson R, Menon M, Kachur SP, McFarland DA. Exploring the impact of targeted distribution of free bed nets on households bed net ownership, socio-economic disparities and childhood malaria infection rates: analysis of national malaria survey data from three sub-Saharan Africa countries. Malar J. 2013;12:245. doi: 10.1186/1475-2875-12-245.
    1. Cotter C, Sturrock HJ, Hsiang MS, Liu J, Phillips AA, Hwang J, et al. The changing epidemiology of malaria elimination: new strategies for new challenges. Lancet. 2013;382:900–11. doi: 10.1016/S0140-6736(13)60310-4.
    1. Rogers DJ, Randolph SE, Snow RW, Hay SI. Satellite imagery in the study and forecast of malaria. Nature. 2002;415:710. doi: 10.1038/415710a.
    1. Jusot JF, Alto O. Short term effect of rainfall on suspected malaria episodes at Magaria, Niger: a time series study. Trans R Soc Trop Med Hyg. 2011;105:637. doi: 10.1016/j.trstmh.2011.07.011.
    1. White NJ, Nosten F, Looareesuwan S, Watkins WM, Marsh K, Snow RW, et al. Averting a malaria disaster. Lancet. 1999;353:1965. doi: 10.1016/S0140-6736(98)07367-X.
    1. Cohen JM, Smith DL, Cotter C, Ward A, Yamey G, Sabot OJ, et al. Malaria resurgence: a systematic review and assessment of its causes. Malar J. 2012;11:122. doi: 10.1186/1475-2875-11-122.
    1. Gething PW, Patil AP, Smith DL, Guerra CA, Elyazar IR, Johnston GL, et al. A new world malaria map: Plasmodium falciparum endemicity in 2010. Malar J. 2011;10:378. doi: 10.1186/1475-2875-10-378.

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