title: Encouraging impact following 2.5 years of reinforced malaria control interventions in a hyperendemic region of the Republic of Guinea.
abstract: Malaria is one of the principal causes of morbidity and mortality in the Republic of Guinea, particularly in the highly endemic regions. To assist in malaria control efforts, a multi-component malaria control intervention was implemented in the hyperendemic region of Guéckédou Prefecture. The coverage of the intervention and its impact on malaria parasite prevalence were assessed.
  
  
  
  Five cross-sectional surveys using cluster-based sampling and stratified by area were conducted from 2011 to 2013 in three sous-préfectures of Guéckédou Préfecture that received the intervention: Guéckédou City, Tékoulo and Guendembou in addition to one comparison sous-préfecture that did not receive the intervention, Koundou. Surveys were repeated every 6 months, corresponding with the dry and rainy seasons. Rapid diagnostic tests (RDT) were used to diagnose malaria infection. In each selected household, bed net use and ownership were assessed.
  
  
  
  A total of 35,123 individuals participated in the surveys. Malaria parasite prevalence declined in all intervention sous-préfectures from 2011 to 2013 (56.4-45.9 % in Guéckédou City, 64.9-54.1 % in Tékoulo and 69.4-56.9 % in Guendembou) while increasing in the comparison sous-préfecture (64.5-69 %). It was consistently higher in children 5-14 years of age followed by those 1-59 months and ≥15 years. Indicators of intervention coverage, the proportion of households reporting ownership of at least one bed net and the proportion of survey participants with fever who received treatment from a health facility or community health worker also increased significantly in the intervention areas.
  
  
  
  Implementation of the multi-component malaria control intervention significantly reduced the prevalence of malaria in the sous-préfectures of intervention while also increasing the coverage of bed nets. However, malaria prevalence remains unacceptably high and disproportionately affects children <15 years of age. In such situations additional vector control interventions and age specific interventions should be considered.
authors.affiliation: Epicentre, Geneva, Switzerland. amanda.tiffany@geneva.msf.org.
authors.forename: Amanda
authors.initials: A
authors.lastname: Tiffany
authors.affiliation: Médecins Sans Frontières, Guéckédou, Guinea.
authors.forename: Faya Pascal
authors.initials: FP
authors.lastname: Moundekeno
authors.affiliation: District Préfectoral de la Santé, Guéckédou, Guinea.
authors.forename: Alexis
authors.initials: A
authors.lastname: Traoré
authors.affiliation: Médecins Sans Frontières, Conakry, Guinea.
authors.forename: Melat
authors.initials: M
authors.lastname: Haile
authors.affiliation: Médecins Sans Frontières, Geneva, Switzerland.
authors.forename: Esther
authors.initials: E
authors.lastname: Sterk
authors.affiliation: National Malaria Control Programme, Conakry, Guinea.
authors.forename: Timothée
authors.initials: T
authors.lastname: Guilavogui
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland.|Infectious Disease Service and Department of Ambulatory Care, University Hospital Lausanne, Lausanne, Switzerland.
authors.forename: Blaise
authors.initials: B
authors.lastname: Genton
authors.affiliation: Médecins Sans Frontières, Guéckédou, Guinea.
authors.forename: Micaela
authors.initials: M
authors.lastname: Serafini
authors.affiliation: Epicentre, Paris, France.
authors.forename: Rebecca F
authors.initials: RF
authors.lastname: Grais
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003140:Communicable Disease Control / Q000379:methods*; D003430:Cross-Sectional Studies; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D019353:Endemic Diseases; D005260:Female; D016701:Guinea / Q000453:epidemiology; D006302:Health Services Research; D006801:Humans; D007223:Infant; D008288:Malaria / Q000453:epidemiology* / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D057147:Mosquito Nets / Q000706:statistics & numerical data; D015995:Prevalence; D055815:Young Adult
keywords: Cross sectional surveys; Guinea; Hyperendemic; Malaria; Plasmodium falciparum; Prevalence; Symptomatic