Disparities of Plasmodium falciparum infection, malaria-related morbidity and access to malaria prevention and treatment among school-aged children: a national cross-sectional survey in Côte d’Ivoire

Abstract

BackgroundThere is limited knowledge on the malaria burden of school-aged children in Côte d’Ivoire. The aim of this study was to assess Plasmodium falciparum infection, malaria-related morbidity, use of preventive measures and treatment against malaria, and physical access to health structures among school-aged children across Côte d’Ivoire.MethodsA national, cross-sectional study was designed, consisting of clinical and parasitological examinations and interviews with schoolchildren. More than 5,000 children from 93 schools in Côte d’Ivoire were interviewed to determine household socioeconomic status, self-reported morbidity and means of malaria prevention and treatment. Finger-prick blood samples were collected and Plasmodium infection and parasitaemia determined using Giemsa-stained blood films and a rapid diagnostic test (RDT). Haemoglobin levels and body temperature were measured. Children were classified into wealth quintiles using household assets and principal components analysis (PCA). The concentration index was employed to determine significant trends of health variables according to wealth quintiles. Logistic and binomial negative regression analyses were done to investigate for associations between P. falciparum prevalence and parasitaemia and any health-related variable.ResultsThe prevalence of P. falciparum was 73.9% according to combined microscopy and RDT results with a geometric mean of parasitaemia among infected children of 499 parasites/μl of blood. Infection with P. falciparum was significantly associated with sex, socioeconomic status and study setting, while parasitaemia was associated with age. The rate of bed net use was low compared to the rate of bed net ownership. Preventive measures (bed net ownership, insecticide spray and the reported use of malaria treatment) were more frequently mentioned by children from wealthier households who were at lower risk of P. falciparum infection. Self-reported morbidity (headache) and clinical morbidity (anaemia) were more often reported by children from less wealthy households.ConclusionSeven out of ten school-aged children in Côte d’Ivoire are infected with P. falciparum and malaria-related morbidity is considerable. Furthermore, this study points out that bed net usage is quite low and there are important inequalities in preventive measures and treatment. These results can guide equity-oriented malaria control strategies in Côte d’Ivoire.Electronic supplementary materialThe online version of this article (doi:10.1186/1475-2875-14-7) contains supplementary material, which is available to authorized users.

Insecticide-treated net effectiveness at preventing Plasmodium falciparum infection varies by age and season

“…However, the study did not address effect modification related to age [22]. Studies in other settings that have included SAC found either varying efficacy of ITNs among SAC [30, 31] or varying efficacy by age [32]. By evaluating effect modification by age, this study was able to identify heterogeneity in the efficaciousness of ITNs by age group and season, perhaps explaining some of the inconsistency in magnitude of previous results.…”

Zika and chikungunya: mosquito‐borne viruses in a changing world

“…Variation in wealth has been linked to human exposure in multiple vector‐borne disease systems across resource‐wealthy and resource‐poor nations . This is due, in part, to changes in mosquito breeding habitats around the home, land cover, availability of other food sources, access to public health infrastructure (e.g., vaccines and therapeutics), and access to education and to intervention strategies, such as bed nets . The proportion of a population of a given age or sex can also influence exposure to vector‐borne disease via age‐, sex‐, or even pregnancy‐related differences in human behavior .…”

“…154,155 This is due, in part, to changes in mosquito breeding habitats around the home, 156 land cover, [157][158][159][160][161] availability of other food sources, [162][163][164] access to public health infrastructure (e.g., vaccines and therapeutics), 165 and access to education and to intervention strategies, such as bed nets. 166,167 The proportion of a population of a given age or sex can also influence exposure to vector-borne disease via age-, sex-, or even pregnancy-related differences in human behavior. [166][167][168] Current mapping efforts, which highlight the transmission risk of CHIKV and ZIKV globally, fail to incorporate these factors.…”

“…166,167 The proportion of a population of a given age or sex can also influence exposure to vector-borne disease via age-, sex-, or even pregnancy-related differences in human behavior. [166][167][168] Current mapping efforts, which highlight the transmission risk of CHIKV and ZIKV globally, fail to incorporate these factors. 169,170 Thus, predicting the risk of CHIKV transmission in novel regions requires understanding the relative importance of the environmental and genetic determinants of transmission potential and the interactions among them and the socioeconomic and demographic predictors of human exposure.…”

Use of Insecticides in Agriculture and the Prevention of Vector-Borne Diseases: Population Knowledge, Attitudes, Practices and Beliefs in Elibou, South Côte d’Ivoire

“…According to the World Health Organization, malaria is endemic in Côte d'Ivoire and the entire population is at risk of malaria transmission [1]. The main preventive measure is sleeping under LLINs [13]. Unfortunately, resistance to pyrethroids, which is the single class of insecticides currently approved for net impregnation, is widespread in Africa [14,15].…”