Stratification and Adaptation of Malaria Control Interventions in Chad
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Site
2.2. Data Collection
2.2.1. Malaria Data
2.2.2. Environmental Data
2.2.3. Population Data
2.2.4. Data Quality Checking
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- Register and MMR data mismatch rate
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- Data agreement rate = 100 − discrepancy rate
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- greater than 95% was labeled good data quality;
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- between 90 to 95% was labeled average data quality;
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- less than 90% was labeled poor data quality.
2.2.5. Data Analysis
Annual Incidence of Malaria
Scenario 1: Crude Incidence
Scenario 2: Incidence Adjusted for Biological Confirmation Rate
Scenario 3: Incidence Adjusted for Health Facility Attendance Rate
Scenario 4: Incidence Adjusted for Laboratory Diagnosis Confirmation and Attendance Rates
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- Very low malaria transmission zone: incidence less than 100 cases per 1000 person (or parasite prevalence < 1%).
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- Low malaria transmission zone: incidence between 100 to 250 cases per 1000 person (or parasite prevalence 1–10%);
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- Moderate malaria transmission zone: incidence between 250 to 450 cases per 1000 person (or parasite prevalence between 10–35%);
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- High malaria transmission zone: incidence greater than 450 cases per 1000 person (or parasite prevalence > 35%).
Prevalence of Malaria
Distribution of Malaria Parasites
Infant and Child Mortality
Meteorological Data
Entomology
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- Mortality < 90%: Resistance confirmed;
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- Mortality between 90–97%: Probable resistance;
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- Mortality between 98–100%: Susceptible.
Seasonality of Malaria
Targeting of Interventions by Transmission Zone
2.2.6. Statistical Tools
2.2.7. Ethical Considerations
3. Results
3.1. Malaria Incidence
3.2. Malaria Crude Incidence
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- One hundred and two (102) health districts are in the very low malaria transmission zone;
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- Nineteen (19) health districts are in the low malaria transmission zone;
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- Six (6) health districts are in the moderate malaria transmission zone;
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- Two (2) health districts are in the high malaria transmission zone.
3.3. Incidence Adjusted for Malaria Laboratory Confirmation Rate
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- Eighty-seven (87) health districts are in the very low malaria transmission zone;
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- Twenty-nine (29) health districts are in the low malaria transmission zone;
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- Eleven (11) health districts are in the moderate malaria transmission zone;
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- Two (2) health districts are in the high malaria transmission zone.
3.4. Incidence Adjusted for Attendance Rate
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- Twenty-eight (28) health districts are in the very low malaria transmission zone;
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- Thirty-nine (39) health districts are in the low malaria transmission zone;
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- Forty-one (41) health districts are in the moderate malaria transmission zone;
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- Twenty-one (21) health districts are in the high malaria transmission zone.
Accessibility to Health Services
3.5. Incidence Adjusted for Malaria Laboratory Confirmation and Attendance Rates
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- Twenty-five (25) health districts are in the very low malaria transmission zone, including five (5) districts with an incidence <10 per 1000, nine (9) districts with an incidence between 10 and <50 per 1000 and 11 districts with an incidence between 50 and <100 cases per 1000 person;
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- Twenty (20) health districts are in the low malaria transmission zone;
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- Forty-six (46) health districts are in the moderate malaria transmission zone;
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- Thirty-eight (38) health districts are in the high malaria transmission zone.
3.6. Incidence of Malaria in Children under Five (5) Years Old
3.7. The Prevalence of Malaria
3.8. Distribution of Parasitic Species in Chad
3.9. Infant and Child Mortality
3.10. Weather Factors from 2017 to 2021
3.10.1. Rainfall Situation by Health District
3.10.2. Health Districts and Period of High Transmission
Estimation of Malaria Seasonality in Districts
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- Five (5) health districts have two (2) months of high malaria transmission period;
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- Nineteen (19) health districts with three (3) months of high malaria transmission period;
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- Thirty-two (32) health districts with four (4) months of high malaria transmission period;
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- Forty-four (44) health districts have five (5) months of high malaria transmission period;
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- Nine (9) health districts have six (6) months of high malaria transmission period;
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- Two (2) health districts with seven (7) months of high malaria transmission period.
3.11. Targeting of Interventions by Stratum
3.12. Health Districts Eligible for SMC and Number of Visits
3.13. Districts Eligible for SMC and Start-Up Months
4. Discussion
4.1. Malaria Incidence
4.2. Incidence of Malaria in Children under Five (5) Years Old
4.3. Prevalence of Malaria in Children Aged 6–59 Months Old
4.4. Infant and Child Mortality
4.5. Interventions by Stratum
4.6. Seasonal Malaria Chemoprophylaxis (SMC)
5. Conclusions
6. Ethical Considerations
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
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Strata | Incidence Level | Interventions |
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Very low transmission | Incidence <10 cases per 1000 | Case management, passive case detection, Active case detection, IPTp, Routine LLINs, IRS, Survence |
Incidence between 10 and <50 cases per 1000 | Case management, IPTp, Routine LLINs, IRS: Reponse to epidemics | |
Incedence between 50 and <100 cases per 1000 | Case management, IPTp, Routine and campaign LLINs, IRS: Reponse to epidemics, SMC | |
Low transmission | Incidence between 100 and <250 cases per 1000 | Case management, IPTp, Routine and campaign LLIN-PBO, SMC, IRS: Reponse to epidemics |
Moderate transmission | Incidence between 250 and <450 cases per 1000 | Case management, iCCM, IPTp, Routine and campaign LLIN-PBO, SMC |
Strong transmission | Incidence greater than 450 cases per 1000 | Case management, iCCM, IPTp, Routine and campaign LLIN-PBO, SMC, IRS |
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Share and Cite
Djaskano, M.I.; Cissoko, M.; Diar, M.S.I.; Israel, D.K.; Clément, K.H.; Ali, A.M.; Dormbaye, M.; Souleymane, I.M.; Batrane, A.; Sagara, I. Stratification and Adaptation of Malaria Control Interventions in Chad. Trop. Med. Infect. Dis. 2023, 8, 450. https://doi.org/10.3390/tropicalmed8090450
Djaskano MI, Cissoko M, Diar MSI, Israel DK, Clément KH, Ali AM, Dormbaye M, Souleymane IM, Batrane A, Sagara I. Stratification and Adaptation of Malaria Control Interventions in Chad. Tropical Medicine and Infectious Disease. 2023; 8(9):450. https://doi.org/10.3390/tropicalmed8090450
Chicago/Turabian StyleDjaskano, Mahamat Idriss, Mady Cissoko, Mahamat Saleh Issakha Diar, Demba Kodindo Israel, Kerah Hinzoumbé Clément, Aicha Mohamed Ali, Makido Dormbaye, Issa Mahamat Souleymane, Adam Batrane, and Issaka Sagara. 2023. "Stratification and Adaptation of Malaria Control Interventions in Chad" Tropical Medicine and Infectious Disease 8, no. 9: 450. https://doi.org/10.3390/tropicalmed8090450