@article{fdi:010074318,
  title = {{A}nother challenge in malaria elimination efforts : the increase of malaria among adults after the implementation of long-lasting insecticide-treated nets ({LLIN}s) in {D}ielmo, {S}enegal},
  author = {{W}otodjo, {A}. {N}. and {D}oucoure, {S}. and {D}iagne, {N}. and {S}arr, {F}. {D}. and {P}arola, {P}. and {G}audart, {J}. and {S}okhna, {C}heikh},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground: {T}he widespread use of artemisinin-based combination therapy ({ACT}) and long-lasting insecticide-treated nets ({LLIN}s) has led to an impressive decrease of malaria burden these recent years in {A}frica. {H}owever, some new challenges about the future of malaria control and elimination efforts have appeared. {A}mong these challenges, the loss and-or-the only partial acquisition of anti-{P}lasmodium immunity among exposed populations lead to an increase of the age at risk of malaria. {I}ndeed, older children and adults may become more vulnerable to malaria. {S}tudies about malaria among adults seemed, therefore, important. {T}his study investigated the evolution of malaria morbidity in adults of {D}ielmo ({S}enegal) before and after the implementation of {LLIN}s. {M}ethods: {F}rom {A}ugust 2007 to {J}uly 2015, a longitudinal study involving adults above 15 years old was carried out in {D}ielmo, where {ACT} was introduced in {J}une 2006 and {LLIN}s in {J}uly 2008. {I}n {J}uly 2011 and {A}ugust 2014, all {LLIN}s were renewed. {T}he presence of each person in the village was monitored daily. {T}hick smears associated lately with rapid diagnosis test ({RDT}) and quantitative polymerase chain reaction methods were performed for all cases of fever. {T}o assess malaria prevalence, thick smears and {RDT} were performed quarterly in all individuals. {M}alaria risks factors were assessed using negative binomial regression mixed-model based on person-trimester observations. {R}esults: {M}alaria morbidity among adults has decreased significantly since the implementation of {LLIN}s in {D}ielmo. {H}owever, malaria resurgences have occurred twice during the 7 years of {LLIN}s use. {D}uring these malaria resurgences, the overall incidence of malaria among adults was similar to the incidence during the year before the implementation of {LLIN}s (adjusted incidence rate ratio [95% {CI}] a{IRR} = 1.04 [0.66-1.64], p = 0.88 and a{IRR} = 1.16 [0.74-1.80], p = 0.52 during the first and the second malaria resurgence period, respectively). {Y}ounger adults were most vulnerable during these malaria upsurges as the incidence of malaria increased significantly among them (chi(2) = 5.2; p = 0.02). {C}onclusion: {M}alaria among adults especially younger adults should deserve more attention in the areas where malaria was previously endemic as they became vulnerable probably because of the partial acquisition and-or-the loss of anti-{P}lasmodium relative immunity and the non regular use of {LLIN}s.},
  keywords = {{M}alaria morbidity ; {M}alaria resurgences ; {A}dults ; {LLIN}s ; {D}ielmo ; {S}enegal ; {SENEGAL} ; {DIELMO}},
  booktitle = {},
  journal = {{M}alaria {J}ournal},
  volume = {17},
  numero = {},
  pages = {art. 384 [9 p.]},
  ISSN = {1475-2875},
  year = {2018},
  DOI = {10.1186/s12936-018-2536-6},
  URL = {https://www.documentation.ird.fr/hor/fdi:010074318},
}