In order to determine the incidence and prevalence of clinical malaria in children exposed since birth to intense and perennial transmission, two successive longitudinal surveys, a weekly survey over four months and a daily survey over 10 days, were carried out in 1983-1984 among 182 children aged 5-13 years in Linzolo, Republic of the Congo, a village where malaria is holoendemic. By age group, prevalence of clinical malaria was found to be between 3.2% and 2.4% at ages 5-6 years, between 2.5% and 1.8% at ages 7-8 years, between 1.6% and 1.1% at ages 9-10 years, and between 0.5% and 0.3% at ages 11-13 years. For these four age groups, respectively, the annual incidence of clinical malaria was estimated during the first survey as 3.0, 2.1, 1.8, and 1.2 attacks, and during the second survey as 5.2, 2.7, 2.0, and 0.8 attacks. No difference was observed in the incidence of malarial attacks between children who use bed-nets and those who do not use them. Also investigated were the customs of the inhabitants of the village in the presence of febrile syndromes in the children, and the importance of antimalarial drug consumption in these cases. It was observed that almost all of these syndromes were rapidly treated with antimalarials, and that in half of the cases these drugs were administered by the parents themselves.

The current incidence of pernicious attacks and of mortality due to malaria were studied in Brazzaville. The results of this study, which concerned all the medical units of the town, were analysed in terms of previous studies on the epidemiology of malaria transmission in the various districts of the town. It was estimated that the annual incidence of pernicious attacks in children in Brazzaville is 1.15 per thousand between 0 and 4 years, 0.25 per thousand between 5 and 9 years and 0.05 per thousand between 10 and 14 years. The annual mortality due to malaria was estimated at 0.43 per thousand between 0 and 4 years and 0.08 per thousand between 5 and 9 years. These values are about 30 times lower than those expected from the results of previous studies of the mortality due to malaria in intertropical Africa. Whereas considerable differences in intensity of malaria transmission exist in the different districts of Brazzaville, the incidence of pernicious attacks and the resulting mortality are remarkably unvarying whatever the level of transmission. In particular, similar results were observed for the sector Mfilou-Ngamaba-Ngangouoni, where malaria is holoendemic with over 100 infective bites per person per year and a parasite rate of 80.95% in schoolchildren, and the central sector of Poto-Poto-Ouenze-Moungali, where malaria is hypoendemic with less than one infective bite per person every three years and a parasite rate of less than 4% in schoolchildren. These results are discussed in terms of previous observations in urban and surrounding rural areas.(ABSTRACT TRUNCATED AT 250 WORDS)

BackgroundDespite social inequalities in overweight/obesity prevalence, evidence-based public health interventions to reduce them are scarce. The PRALIMAP-INÈS trial aimed to investigate whether a strengthened-care management for adolescents with low socioeconomic status has an equivalent effect in preventing and reducing overweight as a standard-care management for high socioeconomic status adolescents.MethodsPRALIMAP-INÈS was a mixed, prospective and multicenter trial including 35 state-run schools. It admitted overweight or obese adolescents, age 13–18 years old, for 3 consecutive academic years. One-year interventions were implemented. Data were collected before (T0), after (T1) and post (T2) intervention. Among 2113 eligible adolescents who completed questionnaires, 1639 were proposed for inclusion and 1419 were included (220 parental refusals). Two groups were constituted according to the Family Affluence Scale (FAS) score: the less advantaged (FAS≤5) were randomly assigned to 2 groups in a 2/1 ratio. The 3 intervention groups were: advantaged with standard-care management (A.S, n = 808), less advantaged with standard-care management (LA.S, n = 196), and less advantaged with standard and strengthened-care management (LA.S.S, n = 415). The standard-care management was based on the patient education principle and consisted of 5 collective sessions. The strengthened-care management was based on the proportionate universalism principle and consisted of activities adapted to needs.Inclusion resultsThe written parental refusal was less frequent among less advantaged and more overweight adolescents. A dramatic linear social gradient in overweight was evidenced.DiscussionThe PRALIMAP-INÈS outcomes should inform how effectively a socially adapted public health program can avoid worsening social inequalities in overweight adolescents attending school.Trial registrationClinicalTrials.gov (NCT01688453).

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