A cohort study to identify risk factors for Plasmodium falciparum infection in Burkinabe children: implications for othe
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Malaria Journal Open Access
RESEARCH
A cohort study to identify risk factors for Plasmodium falciparum infection in Burkinabe children: implications for other high burden high impact countries Jean Baptiste Yaro1,2, Alphonse Ouedraogo1, Z. Amidou Ouedraogo1, Amidou Diarra1, Malik Lankouande1, Efundem Agboraw3, Eve Worrall3, Kobié Hyacinthe Toe1, Antoine Sanou1,4, W. Moussa Guelbeogo1, N’Fale Sagnon1, Hilary Ranson3, Alfred B. Tiono1, Steven W. Lindsay2 and Anne L. Wilson3*
Abstract Background: Progress in controlling malaria has stalled in recent years. Today the malaria burden is increasingly concentrated in a few countries, including Burkina Faso, where malaria is not declining. A cohort study was conducted to identify risk factors for malaria infection in children in southwest Burkina Faso, an area with high insecticide-treated net (ITN) coverage and insecticide-resistant vectors. Methods: Incidence of Plasmodium falciparum infection was measured in 252 children aged 5 to 15 years, using active and passive detection, during the 2017 transmission season, following clearance of infection. Demographic, socio-economic, environmental, and entomological risk factors, including use of ITNs and insecticide resistance were monitored. Results: During the six-month follow-up period, the overall incidence of P. falciparum infection was 2.78 episodes per child (95% CI = 2.66–2.91) by microscopy, and 3.11 (95% CI = 2.95–3.28) by polymerase chain reaction (PCR). The entomological inoculation rate (EIR) was 80.4 infective bites per child over the six-month malaria transmission season. At baseline, 80.6% of children were reported as sleeping under an ITN the previous night, although at the last survey, 23.3% of nets were in poor condition and considered no longer protective. No association was found between the rate of P. falciparum infection and either EIR (incidence rate ratio (IRR): 1.00, 95% CI: 1.00–1.00, p = 0.08) or mortality in WHO tube tests when vectors were exposed to 0.05% deltamethrin (IRR: 1.05, 95% CI: 0.73–1.50, p = 0.79). Travel history (IRR: 1.52, 95% CI: 1.45–1.59, p 50% at the 5% level of significance, assuming 50% prevalence of the risk factor of interest in the population using the formula for comparison of two rates [32]. The study is reported following STROBE guidelines [33].
Fig. 2 Study flowchart
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Results Of 300 randomly selected children, 252 children aged 5–15 years old were enrolled in the cohort after confirmation of parasite clearance by PCR (Fig. 2). Of these 252 children, 228 were clear of infection at day 21 post-ACT, while an additional 24 children were enrolled following receipt of a second course of ACT due to re-infection. Three children withdrew from the study due to migration. No deaths were recorded among the cohort during the study period. The mean age of cohort participants was 9.9 years, 52.0% of whom were male (Table 1). 38.9% of children were Gouin, 21.8% Karaboro, 11.5% Mossi, 9.1% Turka, 6.3% Fulani, and 4.4% Senoufo. Caregivers were predominantly illitera
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