title: No evidence of decline in malaria burden from 2006 to 2013 in a rural Province of Gabon: implications for public health policy.
abstract: BACKGROUND
  The morbidity of malaria has steady declined in the urban regions of Gabon between 2000 and 2008, but caution should be exercised before generalizing this trend to the whole country because this finding has not been systematically confirmed in remote rural provinces.
  
  
  METHODS
  We conducted a retrospective survey using data on malaria cases recorded in North Eastern Gabon between 2006 and 2013 at health facilities in Makokou. Malaria data were analyzed, and associations with annual variations and patient age were assessed.
  
  
  RESULTS
  A global increase in clinical and confirmed malaria cases was observed over the study period. The rate of infection was significantly higher in children aged between 0 to 4 years than in children of 5 years and above, and in adults. Contrary to prior observations in urban and semi-urban areas of Gabon, malaria burden remained mostly unchanged or even increased in Makokou in the Ogooué-Ivindo province during these last 8 years.
  
  
  CONCLUSIONS
  The persistence of Plasmodium falciparum pockets of sustained malaria transmission in rural Gabon may be related to an inadequate coverage of key interventions, to poor treatment seeking behavior and/or to a decline efficacy of treatments. Our results highlight the need to better adapt malaria control strategies to local epidemiological contexts and to environmental constraints. Equitable delivery of health service to hard-to-reach populations constitutes a challenging issue for the health authorities of Gabon.
authors: Unité de Parasitologie Médicale, Centre International de Recherches Médicales de Franceville, Franceville, BP 769, Gabon. vane_assele@yahoo.fr.
authors: Vanessa
authors: V
authors: Assele
authors: Unité de Recherche et d'Analyses Médicales, Centre International de Recherches Médicales de Franceville, Franceville, Gabon. ellandohgildas@ymail.com.
authors: Gildas Ella
authors: GE
authors: Ndoh
authors: Unité de Recherche et d'Analyses Médicales, Centre International de Recherches Médicales de Franceville, Franceville, Gabon. dnkoghe@hotmail.com.
authors: Dieudonné
authors: D
authors: Nkoghe
authors: Unité de Parasitologie Médicale, Centre International de Recherches Médicales de Franceville, Franceville, BP 769, Gabon. thierryfandeur@yahoo.fr.
authors: Thierry
authors: T
authors: Fandeur
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003140:Communicable Disease Control / Q000458:organization & administration*; D005260:Female; D005681:Gabon / Q000453:epidemiology; D006291:Health Policy; D006801:Humans; D007223:Infant; D008288:Malaria / Q000175:diagnosis* / Q000453:epidemiology* / Q000517:prevention & control; D020380:Needs Assessment / Q000458:organization & administration; D010963:Plasmodium falciparum / Q000302:isolation & purification; D011314:Preventive Health Services; D011322:Primary Prevention; D011640:Public Policy; D012189:Retrospective Studies; D012424:Rural Population / Q000706:statistics & numerical data*
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