Research Article: The Great Failure of Malaria Control in Africa: A District Perspective from Burkina Faso

Date Published: June 5, 2007

Publisher: Public Library of Science

Author(s): Bocar Kouyaté, Ali Sie, Maurice Yé, Manuela De Allegri, Olaf Müller

Abstract: Too many African children are dying from a disease for which we have effective and cost-effective prevention and treatment options, say the authors.

Partial Text: Malaria remains the most important parasitic disease affecting humans [1]. Every year, there are some 5 billion clinical episodes resembling malaria, some 600 million clinical malaria cases, and about 1 million malaria deaths [2]. The great majority of the malaria burden falls on the poor rural communities in sub-Saharan Africa (SSA), and most deaths occur in young children [1,2]. Malaria is considered a major barrier to the development of SSA [3].

Burkina Faso, situated in the Sahel zone of West Africa, is one of the poorest countries in the world [14]. State and external aid cover respectively 18% and 28% of all health expenditure; the remaining 54% is financed directly by the population [14]. Governmental health spending equals US$9 per capita per year. A total of three teaching hospitals, 11 regional hospitals, and 55 district hospitals serve the country. While the regional hospitals have specialist units and are run by physicians, the district hospitals are run by nurses with some supervision, usually from two physicians in charge of the whole district. Consequently, formal health services for the rural population are limited to small health centres staffed by two nurses and one midwife.

Malaria in Burkina Faso, predominantly caused by Plasmodium falciparum, is highly endemic and the leading cause for morbidity and mortality [15,16]. In vivo chloroquine resistance was first reported in 1988 and clinical failure rates in children with uncomplicated malaria were around 5% in the early 1990s [17]. However, more recent data have shown a rapid increase of chloroquine but not pyrimethamine–sulfadoxine resistance over the last few years [18–21].

Nouna Health District (NHD) is situated in north-western Burkina Faso. It has a population of 296,000 living in 274 villages served by 25 local health centres and by a district hospital located in the provincial capital, Nouna (population 25,000).

The difficulties of translating research findings into practice are well known and have been found to be a universal phenomenon [31]. With regard to evidence-based changes of malaria treatment policies, such processes have already been described in detail for selected SSA countries [32,33].

Source:

http://doi.org/10.1371/journal.pmed.0040127

 

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