title: Evidence of decline of malaria in the general hospital of Libreville, Gabon from 2000 to 2008.
abstract: BACKGROUND
  Substantial decline in malaria transmission, morbidity and mortality has been reported in several countries where new malaria control strategies have been implemented. In Gabon, the national malaria policy changed in 2003, according to the WHO recommendations. The trend in malaria morbidity was evaluated among febrile children before and after their implementation in Libreville, the capital city of Gabon.
  
  
  METHODS
  From August 2000 to December 2008, febrile paediatric outpatients and inpatients, under 11 years of age, were screened for malaria by microscopic examination at the Malaria Clinical Research Unit (MCRU) located in the largest public hospital in Gabon. Climatic data were also collected.
  
  
  RESULTS
  In total, 28,092 febrile children were examined; those under five years always represented more than 70%. The proportion of malaria-positive slides was 45% in 2000, and declined to 15% in 2008. The median age of children with a positive blood smear increased from 24(15-48) to 41(21-72) months over the study period (p < 0.01). Rainfall patterns had no impact on the decline observed throughout the study period.
  
  
  CONCLUSIONS
  The decrease of malaria prevalence among febrile children during the last nine years is observed following the introduction of new strategies of malaria cases management, and may announce epidemiological changes. Moreover, preventive measures must be extended to children older than five years.
authors.affiliation: Department of Parasitology-Mycology and Tropical Medicine, Faculty of Medicine, Université des Sciences de la Santé, BP 4009 Libreville, Gabon. mariellebouyou@gmail.com
authors.forename: Marielle Karine
authors.initials: MK
authors.lastname: Bouyou-Akotet
authors.forename: Denise Patricia
authors.initials: DP
authors.lastname: Mawili-Mboumba
authors.forename: Eric
authors.initials: E
authors.lastname: Kendjo
authors.forename: Modeste
authors.initials: M
authors.lastname: Mabika-Mamfoumbi
authors.forename: Edgard Brice
authors.initials: EB
authors.lastname: Ngoungou
authors.forename: Arnaud
authors.initials: A
authors.lastname: Dzeing-Ella
authors.forename: Mireille
authors.initials: M
authors.lastname: Pemba-Mihindou
authors.forename: Euloge
authors.initials: E
authors.lastname: Ibinga
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Efame-Eya
authors.forename: Tim
authors.initials: T
authors.lastname: Planche
authors.forename: Peter G
authors.initials: PG
authors.lastname: Kremsner
authors.forename: Maryvonne
authors.initials: M
authors.lastname: Kombila
mesh_terms: D000367:Age Factors; D000818:Animals; D001769:Blood / Q000469:parasitology; D002648:Child; D002675:Child, Preschool; D002980:Climate; D005260:Female; D005681:Gabon / Q000453:epidemiology; D006769:Hospitals, General; D006801:Humans; D007223:Infant; D008288:Malaria / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000635:transmission; D008297:Male; D008853:Microscopy / Q000379:methods; D010961:Plasmodium / Q000166:cytology / Q000302:isolation & purification; D015995:Prevalence