Evolution of malaria mortality and morbidity after the emergence of chloroquine resistance in Niakhar, Senegal.
BACKGROUND
Recently, it has been assumed that resistance of Plasmodium to chloroquine increased malaria mortality. The study aimed to assess the impact of chemoresistance on mortality attributable to malaria in a rural area of Senegal, since the emergence of resistance in 1992, whilst chloroquine was used as first-line treatment of malaria, until the change in national anti-malarial policy in 2003.


METHODS
The retrospective study took place in the demographic surveillance site (DSS) of Niakhar. Data about malaria morbidity were obtained from health records of three health care facilities, where diagnosis of malaria was based on clinical signs. Source of data concerning malaria mortality were verbal autopsies performed by trained fieldworkers and examined by physicians who identified the probable cause of death.


RESULTS
From 1992 to 2004, clinical malaria morbidity represented 39% of total morbidity in health centres. Mean malaria mortality was 2.4 per thousand and 10.4 per thousand among total population and children younger than five years, respectively, and was highest in the 1992-1995 period. It tended to decline from 1992 to 2003 (Trend test, total population p = 0.03, children 0-4 years p = 0.12 - children 1-4 years p = 0.04- children 5-9 years p = 0.01).


CONCLUSIONS
Contrary to what has been observed until 1995, mortality attributable to malaria did not continue to increase dramatically in spite of the growing resistance to chloroquine and its use as first-line treatment until 2003. Malaria morbidity and mortality followed parallel trends and rather fluctuated accordingly to rainfall.
Munier
Aline
A
IRD, Université Paris Descartes, France. munier_aline@yahoo.fr
Diallo
Aldiouma
A
Marra
Adama
A
Cot
Michel
M
Arduin
Pascal
P
Ndiaye
Ousmane
O
Mboup
Balla Mbacké
BM
Gning
Barnabé
B
Chippaux
Jean-Philippe
JP
D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D000962:Antimalarials / Q000494:pharmacology / Q000627:therapeutic use*; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D002738:Chloroquine / Q000494:pharmacology / Q000627:therapeutic use*; D004351:Drug Resistance; D005260:Female; D006801:Humans; D007223:Infant; D008288:Malaria / Q000188:drug therapy* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D009026:Mortality / Q000639:trends; D011159:Population Surveillance; D011891:Rain; D012189:Retrospective Studies; D012675:Senegal / Q000453:epidemiology; D011795:Surveys and Questionnaires; D055815:Young Adult
D000962:Antimalarials; D002738:Chloroquine