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Another challenge in malaria elimination efforts: the increase of malaria among adults after the implementation of long-lasting insecticide-treated nets (LLINs) in Dielmo, Senegal

BACKGROUND: The widespread use of artemisinin-based combination therapy (ACT) and long-lasting insecticide-treated nets (LLINs) has led to an impressive decrease of malaria burden these recent years in Africa. However, some new challenges about the future of malaria control and elimination efforts h...

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Autores principales: Wotodjo, Amélé N., Doucoure, Souleymane, Diagne, Nafissatou, Sarr, Fatoumata Diene, Parola, Philipe, Gaudart, Jean, Sokhna, Cheikh
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6203273/
https://www.ncbi.nlm.nih.gov/pubmed/30359255
http://dx.doi.org/10.1186/s12936-018-2536-6
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author Wotodjo, Amélé N.
Doucoure, Souleymane
Diagne, Nafissatou
Sarr, Fatoumata Diene
Parola, Philipe
Gaudart, Jean
Sokhna, Cheikh
author_facet Wotodjo, Amélé N.
Doucoure, Souleymane
Diagne, Nafissatou
Sarr, Fatoumata Diene
Parola, Philipe
Gaudart, Jean
Sokhna, Cheikh
author_sort Wotodjo, Amélé N.
collection PubMed
description BACKGROUND: The widespread use of artemisinin-based combination therapy (ACT) and long-lasting insecticide-treated nets (LLINs) has led to an impressive decrease of malaria burden these recent years in Africa. However, some new challenges about the future of malaria control and elimination efforts have appeared. Among these challenges, the loss and—or—the only partial acquisition of anti-Plasmodium immunity among exposed populations lead to an increase of the age at risk of malaria. Indeed, older children and adults may become more vulnerable to malaria. Studies about malaria among adults seemed, therefore, important. This study investigated the evolution of malaria morbidity in adults of Dielmo (Senegal) before and after the implementation of LLINs. METHODS: From August 2007 to July 2015, a longitudinal study involving adults above 15 years old was carried out in Dielmo, where ACT was introduced in June 2006 and LLINs in July 2008. In July 2011 and August 2014, all LLINs were renewed. The presence of each person in the village was monitored daily. Thick smears associated lately with rapid diagnosis test (RDT) and quantitative polymerase chain reaction methods were performed for all cases of fever. To assess malaria prevalence, thick smears and RDT were performed quarterly in all individuals. Malaria risks factors were assessed using negative binomial regression mixed-model based on person-trimester observations. RESULTS: Malaria morbidity among adults has decreased significantly since the implementation of LLINs in Dielmo. However, malaria resurgences have occurred twice during the 7 years of LLINs use. During these malaria resurgences, the overall incidence of malaria among adults was similar to the incidence during the year before the implementation of LLINs (adjusted incidence rate ratio [95% CI] aIRR = 1.04 [0.66–1.64], p = 0.88 and aIRR = 1.16 [0.74–1.80], p = 0.52 during the first and the second malaria resurgence period, respectively). Younger adults were most vulnerable during these malaria upsurges as the incidence of malaria increased significantly among them (χ(2) = 5.2; p = 0.02). CONCLUSION: Malaria among adults especially younger adults should deserve more attention in the areas where malaria was previously endemic as they became vulnerable probably because of the partial acquisition and—or—the loss of anti-Plasmodium relative immunity and the non regular use of LLINs.
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spelling pubmed-62032732018-11-01 Another challenge in malaria elimination efforts: the increase of malaria among adults after the implementation of long-lasting insecticide-treated nets (LLINs) in Dielmo, Senegal Wotodjo, Amélé N. Doucoure, Souleymane Diagne, Nafissatou Sarr, Fatoumata Diene Parola, Philipe Gaudart, Jean Sokhna, Cheikh Malar J Research BACKGROUND: The widespread use of artemisinin-based combination therapy (ACT) and long-lasting insecticide-treated nets (LLINs) has led to an impressive decrease of malaria burden these recent years in Africa. However, some new challenges about the future of malaria control and elimination efforts have appeared. Among these challenges, the loss and—or—the only partial acquisition of anti-Plasmodium immunity among exposed populations lead to an increase of the age at risk of malaria. Indeed, older children and adults may become more vulnerable to malaria. Studies about malaria among adults seemed, therefore, important. This study investigated the evolution of malaria morbidity in adults of Dielmo (Senegal) before and after the implementation of LLINs. METHODS: From August 2007 to July 2015, a longitudinal study involving adults above 15 years old was carried out in Dielmo, where ACT was introduced in June 2006 and LLINs in July 2008. In July 2011 and August 2014, all LLINs were renewed. The presence of each person in the village was monitored daily. Thick smears associated lately with rapid diagnosis test (RDT) and quantitative polymerase chain reaction methods were performed for all cases of fever. To assess malaria prevalence, thick smears and RDT were performed quarterly in all individuals. Malaria risks factors were assessed using negative binomial regression mixed-model based on person-trimester observations. RESULTS: Malaria morbidity among adults has decreased significantly since the implementation of LLINs in Dielmo. However, malaria resurgences have occurred twice during the 7 years of LLINs use. During these malaria resurgences, the overall incidence of malaria among adults was similar to the incidence during the year before the implementation of LLINs (adjusted incidence rate ratio [95% CI] aIRR = 1.04 [0.66–1.64], p = 0.88 and aIRR = 1.16 [0.74–1.80], p = 0.52 during the first and the second malaria resurgence period, respectively). Younger adults were most vulnerable during these malaria upsurges as the incidence of malaria increased significantly among them (χ(2) = 5.2; p = 0.02). CONCLUSION: Malaria among adults especially younger adults should deserve more attention in the areas where malaria was previously endemic as they became vulnerable probably because of the partial acquisition and—or—the loss of anti-Plasmodium relative immunity and the non regular use of LLINs. BioMed Central 2018-10-25 /pmc/articles/PMC6203273/ /pubmed/30359255 http://dx.doi.org/10.1186/s12936-018-2536-6 Text en © The Author(s) 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Wotodjo, Amélé N.
Doucoure, Souleymane
Diagne, Nafissatou
Sarr, Fatoumata Diene
Parola, Philipe
Gaudart, Jean
Sokhna, Cheikh
Another challenge in malaria elimination efforts: the increase of malaria among adults after the implementation of long-lasting insecticide-treated nets (LLINs) in Dielmo, Senegal
title Another challenge in malaria elimination efforts: the increase of malaria among adults after the implementation of long-lasting insecticide-treated nets (LLINs) in Dielmo, Senegal
title_full Another challenge in malaria elimination efforts: the increase of malaria among adults after the implementation of long-lasting insecticide-treated nets (LLINs) in Dielmo, Senegal
title_fullStr Another challenge in malaria elimination efforts: the increase of malaria among adults after the implementation of long-lasting insecticide-treated nets (LLINs) in Dielmo, Senegal
title_full_unstemmed Another challenge in malaria elimination efforts: the increase of malaria among adults after the implementation of long-lasting insecticide-treated nets (LLINs) in Dielmo, Senegal
title_short Another challenge in malaria elimination efforts: the increase of malaria among adults after the implementation of long-lasting insecticide-treated nets (LLINs) in Dielmo, Senegal
title_sort another challenge in malaria elimination efforts: the increase of malaria among adults after the implementation of long-lasting insecticide-treated nets (llins) in dielmo, senegal
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6203273/
https://www.ncbi.nlm.nih.gov/pubmed/30359255
http://dx.doi.org/10.1186/s12936-018-2536-6
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