title: Stable malaria incidence despite scaling up control strategies in a malaria vaccine-testing site in Mali.
abstract: BACKGROUND
  The recent decline in malaria incidence in many African countries has been attributed to the provision of prompt and effective anti-malarial treatment using artemisinin-based combination therapy (ACT) and to the widespread distribution of long-lasting, insecticide-treated bed nets (LLINs). At a malaria vaccine-testing site in Bandiagara, Mali, ACT was introduced in 2004, and LLINs have been distributed free of charge since 2007 to infants after they complete the Expanded Programme of Immunization (EPI) schedule and to pregnant women receiving antenatal care. These strategies may have an impact on malaria incidence.
  
  
  METHODS
  To document malaria incidence, a cohort of 400 children aged 0 to 14 years was followed for three to four years up to July 2013. Monthly cross-sectional surveys were done to measure the prevalence of malaria infection and anaemia. Clinical disease was measured both actively and passively through continuous availability of primary medical care. Measured outcomes included asymptomatic Plasmodium infection, anaemia and clinical malaria episodes.
  
  
  RESULTS
  The incidence rate of clinical malaria varied significantly from June 2009 to July 2013 without a clear downward trend. A sharp seasonality in malaria illness incidence was observed with higher clinical malaria incidence rates during the rainy season. Parasite and anaemia point prevalence also showed seasonal variation with much higher prevalence rates during rainy seasons compared to dry seasons.
  
  
  CONCLUSIONS
  Despite the scaling up of malaria prevention and treatment, including the widespread use of bed nets, better diagnosis and wider availability of ACT, malaria incidence did not decrease in Bandiagara during the study period.
authors.forename: Drissa
authors.initials: D
authors.lastname: Coulibaly
authors.forename: Mark A
authors.initials: MA
authors.lastname: Travassos
authors.forename: Abdoulaye K
authors.initials: AK
authors.lastname: Kone
authors.forename: Youssouf
authors.initials: Y
authors.lastname: Tolo
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Laurens
authors.forename: Karim
authors.initials: K
authors.lastname: Traore
authors.forename: Issa
authors.initials: I
authors.lastname: Diarra
authors.forename: Amadou
authors.initials: A
authors.lastname: Niangaly
authors.forename: Modibo
authors.initials: M
authors.lastname: Daou
authors.forename: Ahmadou
authors.initials: A
authors.lastname: Dembele
authors.forename: Mody
authors.initials: M
authors.lastname: Sissoko
authors.forename: Bouréima
authors.initials: B
authors.lastname: Guindo
authors.forename: Raymond
authors.initials: R
authors.lastname: Douyon
authors.forename: Aldiouma
authors.initials: A
authors.lastname: Guindo
authors.forename: Bourema
authors.initials: B
authors.lastname: Kouriba
authors.forename: Mahamadou S
authors.initials: MS
authors.lastname: Sissoko
authors.forename: Issaka
authors.initials: I
authors.lastname: Sagara
authors.forename: Christopher V
authors.initials: CV
authors.lastname: Plowe
authors.forename: Ogobara K
authors.initials: OK
authors.lastname: Doumbo
authors.affiliation: Malaria Research & Training Centre, Department of Epidemiology of Parasitic Diseases, Faculty of Medicine and Dentistry, University of Sciences, Techniques and Technologies, Bamako, Mali. mthera@icermali.org.
authors.forename: Mahamadou A
authors.initials: MA
authors.lastname: Thera
mesh_terms: D000293:Adolescent; D000740:Anemia / Q000453:epidemiology; D058070:Asymptomatic Diseases / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008288:Malaria / Q000150:complications / Q000453:epidemiology*; D008297:Male; D008302:Mali / Q000453:epidemiology; D015995:Prevalence