The lead-up to epidemic transmission: malaria trends and control interventions in Burundi 2000 to 2019

Abstract

Burundi has experienced an increase in malaria cases since 2000, reaching 843,000 cases per million inhabitants in 2019, a more than twofold increase compared to the early 2000s. Burundi thus contrasts the decreasing number of cases in many other African countries. To evaluate the impact of malaria control on this increase, data on interventions from 2000 to 2019 were compiled. Over this period, the number of health facilities increased threefold, and the number of tests 20-fold. The test positivity rate remained stable at around 50–60% in most years. Artemisinin-based combination therapy was introduced in 2003, initially using artesunate–amodiaquine and changed to artemether–lumefantrine in 2019/2020. Mass distribution campaigns of insecticide-treated bed nets were conducted, and indoor residual spraying and intermittent preventive treatment in pregnancy introduced. Thus, the increase in cases was not the result of faltering control activities. Increased testing was likely a key contributor to higher case numbers. Despite the increase in testing, the test positivity rate remined high, indicating that current case numbers might still underestimate the true burden.

Performance of highly sensitive and conventional rapid diagnostic tests for clinical and subclinical Plasmodium falciparum infections, and hrp2/3 deletion status in Burundi

“…The level of malaria transmission in Burundi is among the highest in the world [23,24]. In contrast to the trend in many other countries in sub-Saharan Africa, the number of cases has increased in the last two decades [24].…”

Exploring predictive frameworks for malaria in Burundi

“…The health system still has many challenges, despite efforts by the Government to improve by increasing access to healthcare facilities and technical capacities ( Sinzinkayo et al., 2021 ). Burundi suffers from a shortage of qualified personnel, medical resources, and high burden of diseases ( Lozano & Garrido, 2015 ).…”

High sensitivity of a novel rapid test for the diagnosis of clinical and subclinical Plasmodium falciparum infections in a high transmission setting in Burundi

“…Burundi experiences among the highest levels of malaria transmission globally [21, 22]. In contrast to the trend in many other countries in sub-Saharan Africa, the number of cases has increased in the last two decades [22].…”

“…Burundi experiences among the highest levels of malaria transmission globally [21, 22]. In contrast to the trend in many other countries in sub-Saharan Africa, the number of cases has increased in the last two decades [22]. The increase was observed despite an increase in the number of health centers offering diagnosis and treatment, and increase in testing, and roll-out of interventions such as bed nets and indoor residual spraying (IRS) [22].…”

“…In contrast to the trend in many other countries in sub-Saharan Africa, the number of cases has increased in the last two decades [22]. The increase was observed despite an increase in the number of health centers offering diagnosis and treatment, and increase in testing, and roll-out of interventions such as bed nets and indoor residual spraying (IRS) [22]. To understand the benefit a novel, highly sensitive RDT, suspected febrile cases presenting to a health center, and subclinical community members were tested by the novel RDT, an established RDT, and results compared to highly sensitive qPCR.…”