title: The implication of long-lasting insecticide-treated net use in the resurgence of malaria morbidity in a Senegal malaria endemic village in 2010-2011.
abstract: BACKGROUND
  Although the burden of malaria has significantly declined in recent years in sub-Saharan Africa through the widespread use of long-lasting insecticide treated bed-nets (LLINs) and artemisinin-based combination therapy, resurgence of malaria is observed in some settings after several years of LLINs use. This study aimed to assess if LLINs use remains protective against malaria during a period of resurgence of malaria morbidity in Dielmo, a rural village of Senegal.
  
  
  METHODS
  In July 2008, LLINs were offered to all villagers and lately in July 2011, LLINs were renewed. A longitudinal study was conducted between July, 2010 and December, 2011 among inhabitants of the village of Dielmo to identify all episodes of fever. Thick smears stained with Giemsa were done for every febrile villager and malaria attacks were treated with combination of Artesunate plus Amodiaquine. Cross-sectional surveys were also conducted at the end of the rainy season (October 2010 and November 2011) to assess asymptomatic carriage. A survey on LLINs use was done every quarter of the year. A random-effect logistic regression was used to assess the effect of LLINs use on the risk of having a malaria attack after adjusting for the main risk factors.
  
  
  RESULTS
  The study population included 449 individuals corresponding to a total of 2140 observations. One hundred and fifteen (115) clinical malaria attacks attributed to P. falciparum (cases) have been recorded over the study period. Most of the malaria cases occurred in October-December 2010 (49/115 i.e. 43%) and among adults aged 15 years and over (50/115, i.e. 43%). During the study period, the use of LLINs was 61% among non-malaria cases and only 42% among malaria clinical cases but differenced according to age group. After adjusting on gender, age, rainfall and LLINs replacement, we found that LLINs use (AOR [95%CI] = 0.40 [0.25; 0.62], p < 0.001) remained a protective factor against malaria attacks during the study period.
  
  
  CONCLUSIONS
  LLINs use remains effective to reduce malaria burden. These results highlight the need to pursue LLINs implementation in the current context of malaria elimination and to provide positive incentives to increase its use in the population.
authors.affiliation: Unité de Recherche sur les Maladies Infectieuses et Tropicales Émergentes, IRD198, UM63, CNRS7278, INSERMU1095, Aix-Marseille Université, Campus UCAD-IRD, BP 1386, CP 18524, Dakar, Sénégal. amele-nyedzie.wotodjo@ird.fr.|Université Cheikh Anta Diop de Dakar, Faculté des Sciences et Techniques/Laboratoire de Parasitologie, Dakar, Sénégal. amele-nyedzie.wotodjo@ird.fr.
authors.forename: Amélé N
authors.initials: AN
authors.lastname: Wotodjo
authors.affiliation: Institut Pasteur de Dakar, Unité d'Epidémiologie/ Unité d'immunologie, Dakar, Sénégal. vrichard@pasteur.sn.
authors.forename: Vincent
authors.initials: V
authors.lastname: Richard
authors.affiliation: Aix-Marseille Université, UMR912 SESSTIM (INSERM-IRD-AMU), Marseille, 13005, France. sylvie.boyer@inserm.fr.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Boyer
authors.affiliation: Unité de Recherche sur les Maladies Infectieuses et Tropicales Émergentes, IRD198, UM63, CNRS7278, INSERMU1095, Aix-Marseille Université, Campus UCAD-IRD, BP 1386, CP 18524, Dakar, Sénégal. souleymane.doucoure@ird.fr.
authors.forename: Souleymane
authors.initials: S
authors.lastname: Doucoure
authors.affiliation: Unité de Recherche sur les Maladies Infectieuses et Tropicales Émergentes, IRD198, UM63, CNRS7278, INSERMU1095, Aix-Marseille Université, Campus UCAD-IRD, BP 1386, CP 18524, Dakar, Sénégal. nafissatou.diagne@ird.fr.
authors.forename: Nafissatou
authors.initials: N
authors.lastname: Diagne
authors.affiliation: Institut Pasteur de Dakar, Unité d'Epidémiologie/ Unité d'immunologie, Dakar, Sénégal. atoure@pasteur.sn.
authors.forename: Aissatou
authors.initials: A
authors.lastname: Touré-Baldé
authors.affiliation: Institut Pasteur de Dakar, Unité d'Epidémiologie/ Unité d'immunologie, Dakar, Sénégal. atall@path.org.
authors.forename: Adama
authors.initials: A
authors.lastname: Tall
authors.affiliation: Université Cheikh Anta Diop de Dakar, Faculté des Sciences et Techniques/Laboratoire de Parasitologie, Dakar, Sénégal. nfaye2002@yahoo.fr.
authors.forename: Ngor
authors.initials: N
authors.lastname: Faye
authors.affiliation: Aix-Marseille Université, UMR912 SESSTIM (INSERM-IRD-AMU), Marseille, 13005, France. jean.gaudart@univ-amu.fr.
authors.forename: Jean
authors.initials: J
authors.lastname: Gaudart
authors.affiliation: Institut de Recherche pour le Développement, laboratoire de Paludologie, Dakar, Sénégal. jean-francois.trape@ird.fr.
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Trape
authors.affiliation: Unité de Recherche sur les Maladies Infectieuses et Tropicales Émergentes, IRD198, UM63, CNRS7278, INSERMU1095, Aix-Marseille Université, Campus UCAD-IRD, BP 1386, CP 18524, Dakar, Sénégal. cheikh.sokhna@ird.fr.
authors.forename: Cheikh
authors.initials: C
authors.lastname: Sokhna
mesh_terms: D000293:Adolescent; D000328:Adult; D000655:Amodiaquine / Q000494:pharmacology*; D000818:Animals; D037621:Artemisinins / Q000494:pharmacology*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D060740:Disease Eradication; D004338:Drug Combinations; D005260:Female; D006801:Humans; D007223:Infant; D057148:Insecticide-Treated Bednets; D007306:Insecticides / Q000494:pharmacology*; D008137:Longitudinal Studies; D008288:Malaria / Q000453:epidemiology / Q000517:prevention & control*; D016778:Malaria, Falciparum / Q000453:epidemiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009032:Mosquito Control / Q000379:methods*; D012675:Senegal / Q000453:epidemiology; D055815:Young Adult
chemical_list: D037621:Artemisinins; D004338:Drug Combinations; D007306:Insecticides; C515299:amodiaquine, artesunate drug combination; D000655:Amodiaquine