Low autochtonous urban malaria in Antananarivo (Madagascar).
BACKGROUND
The study of urban malaria is an area undergoing rapid expansion, after many years of neglect. The problem of over-diagnosis of malaria, especially in low transmission settings including urban areas, is also receiving deserved attention. The primary objective of the present study was to assess the frequency of malaria among febrile outpatients seen in private and public primary care facilities of Antananarivo. The second aim was to determine, among the diagnosed malaria cases, the contribution of autochthonous urban malaria.


METHODS
Two cross-sectional surveys in 43 health centres in Antananarivo in February 2003 (rainy season) and in July 2003 (dry season) were conducted. Consenting clinically suspected malaria patients with fever or history of fever in the past 48 hours were included. Malaria rapid diagnostic tests and microscopy were used to diagnose malaria. Basic information was collected from patients to try to identify the origin of the infection: autochthonous or introduced.


RESULTS
In February, among 771 patients, 15 (1.9%) positive cases were detected. Three malaria parasites were implicated: Plasmodium. falciparum (n = 12), Plasmodium vivax (n = 2) and Plasmodium. ovale (n = 1). Only two cases, both P. falciparum, were likely to have been autochthonous (0.26%). In July, among 739 blood smears examined, 11 (1.5%) were positive: P. falciparum (n = 9) and P. vivax (n = 2). Three cases of P. falciparum malaria were considered to be of local origin (0.4%).


CONCLUSIONS
This study demonstrates that malaria cases among febrile episodes are low in Antananarivo and autochthonous malaria cases exist but are rare.
Institut Pasteur de Madagascar, BP 1274 Antananarivo-101, Madagascar, France. leon@pasteur.mg
Léon Paul
LP
Rabarijaona
Frédéric
F
Ariey
Robert
R
Matra
Sylvie
S
Cot
Andrianavalona Lucie
AL
Raharimalala
Louise Henriette
LH
Ranaivo
Jacques
J
Le Bras
Vincent
V
Robert
Milijaona
M
Randrianarivelojosia
D000818:Animals; D000852:Anopheles / Q000469:parasitology; D000953:Antigens, Protozoan / Q000235:genetics; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D008270:Madagascar / Q000453:epidemiology; D008288:Malaria / Q000175:diagnosis* / Q000453:epidemiology* / Q000469:parasitology; D016778:Malaria, Falciparum / Q000175:diagnosis / Q000453:epidemiology; D008297:Male; D010963:Plasmodium falciparum / Q000235:genetics / Q000302:isolation & purification; D041122:Plasmodium ovale / Q000302:isolation & purification; D010966:Plasmodium vivax / Q000302:isolation & purification; D016133:Polymerase Chain Reaction; D015995:Prevalence; D015800:Protozoan Proteins / Q000235:genetics; D012621:Seasons; D014505:Urban Population
D000953:Antigens, Protozoan; D015800:Protozoan Proteins; C065974:merozoite surface protein 2, Plasmodium