Synthesis of Policies Applied in the Fight Against Malaria in two African Countries at different Stages of Intervention (Model of Burkina Faso and Model of Senegal) using Data from Surveys and Literature

Abstract

Background: Malaria is a global public health problem with many cases each year (228 million cases in 2018 with 405,000 deaths). Most malaria cases occur in Africa. Methods: Data used for analysis are from Demographics and Health Surveys (DHS) 2017-2018 for Burkina Faso and DHS 2017 for Senegal. We added information from a synthesis of literature. Linear regression models were performed with an estimation of the mean number of persons using ITNs among groups (urban or rural areas, wealth level, highest education level in the household and age of household head) in each country. We evaluated the importance of co-factors in the relationship between the number of ITNs (insecticide-treated nets) in a household and the number of household members by calculating the R-squared. A criteria grid used for this synthesis of literature included eight important sub-groups: funding sources, entomological monitoring, use of ITNs, use of insecticide, malaria case management, health system organization, communication and surveillance. Results: Senegal and Burkina Faso have the same proportion (51%) of households in which all children under 5 sleep under ITNs. We found R-squared (R2=0.007 in Burkina Faso and R2=0.16 in Senegal) for the relationship between the number of ITNs in a household and household size. When wealth level, age of head of household, area of residence (rural or urban), highest education level in the household and number of bedrooms in the household were controlled for, we found R2=0.106 for Burkina Faso and R2=0.167 for Senegal. We found that Senegal’s national malaria program is decentralized with entomological monitoring in all districts, which is normal considering the intervention stage in the fight against malaria. In Burkina Faso, we found centralization of routine data.Conclusion: Our study synthesized the health policies applied in African countries which are at different stages of intervention in the fight against malaria and which have succeeded in maintaining low malaria prevalence (in Senegal) or in rapidly decreasing the prevalence of the disease (in Burkina Faso). Being close to elimination, Senegal required more active malaria surveillance than passive surveillance. Burkina Faso did not require a lot of active surveillance being not close to malaria elimination. These results merit a review in the context of each African country.