Table 1: Malaria parasite rate, reported fever, LLINs usage and anemia prevalence in children of 6 months to 10 years in areas of LLINs+IRS and LLINs-only in June and October 2016
|
June 2016
|
October 2016
|
Malaria indices
|
LLINs+IRS
(N=950)
Freq (%)
|
LLINs-only
(N=621)
Freq (%)
|
χ2
P- value
|
LLINs+IRS
(N=950)
Freq (%)
|
LLINs-only
(N=621)
Freq (%)
|
χ2
P- value
|
Parasitemia
|
87 (9.15)
|
87 (14.0)
|
0.0027*
|
121 (13.22)
|
253 (42.25)
|
0.0027*
|
Gametocyte index
|
24 (2.53)
|
14 (2.25)
|
0.7316
|
29 (3.17)
|
68 (11.45)
|
0.000***
|
Fever
|
122 (12.84)
|
52 (8.37)
|
0.0058
|
196 (21.42)
|
275 (53.70)
|
0.000***
|
LLINs
|
871 (91.68)
|
130 (20.93)
|
0.000***
|
886 (96.83)
|
530 (89.23)
|
0.000***
|
Anemia
|
306 (32.21)
|
329 (52.97)
|
2.38e-16*
|
409 (44.70)
|
364 (61.28)
|
0.000***
|
The mean age of the study population was 5.6 ± 2.8 years and the sex ratio 1.1 for the male. As shown in Table 1, in June representing the start of the rainy season, malaria parasitemia was significantly lower (P = 0.0027) in LLINs+IRS area (9.2%, n = 950) compared to the area of LLINs-only (14.0%, n = 621). For the gametocyte index, there was no difference between the two areas. Surprisingly prevalence of malaria fever cases was higher (P = 0.0058) in LLIs+IRS area 12.8%, n = 122) than in the area of LLINs-only (8.4%, n = 52). LLINs usage was very high (P < 0.001) in LLINs+IRS area (91.7%, n = 871) compared to the area of LLNs-only (20.9%, n = 130). More anemia cases (P<0.001) were observed in area of LLINs-only (53.0%, n = 323) than in LLINs+IRS area (32.2%, n = 306).
In October, representing the end of the rainy season and the peak of transmission, malaria parasitemia remains significantly lower (P < 0.001) in LLINs+IRS area (13.2%, n = 950) compared to the area of LLINs-only (42.3%, n = 621). However, in both areas, there was an increase in the parasite rate from June to October. This increase was 17.9% (9.2% vs 13.2%) in LLINs+IRS area, and up to 50.3% (14.0% vs 42.3%) in the area of LLINs-only. In opposite to June, where there was no difference in the gametocyte index between the two areas, gametocyte index was significantly higher (P < 0.001) in the area of LLINs-only (11.5%) compared to the LLINs+IRS area (3.2%) in October. The same pattern was observed with the fever. LLNs usage increased in both areas in October compared to June. However, it remained lower in the area of LLINs-only (89.2%, n = 530) compared to the area of LINs+IRS (96.8%, n = 886).
Figure 2 showed the variation of the asexual parasite rate by age group in the two areas. In June there was no significant difference in parasite rate between the two age groups of the same area as well as between the two areas. In October, the parasite rate was significantly higher (P = 0.0007; P = 0.0003) in children of 5–10 years than in those < 5 years in the same area as well as in between areas (P<0.0001).
Table 2: Simple logistic regression between parasitemia and area, age group, fever and LLINs usage, anemia among children of 0-10 years old during the peak of transmission (October 2016)
|
|
Parasitemia
|
|
|
|
Crude OR (95% CI)
|
P-value
|
Areas
|
LLINs+IRS
|
1
|
|
|
LLINs-only
|
4.9 (3.7-6.2)
|
< 0.001***
|
LLINs
|
No
|
|
|
|
Yes
|
0.6 (0.8-1.01)
|
0.05031
|
Age
|
< 5 years
|
1
|
|
|
> 5 years
|
1.6 (1.3-2.1)
|
< 0.001***
|
Fever
|
No
|
1
|
|
|
Yes
|
4.6 (3.3-6.4)
|
< 0.001***
|
Anemia
|
No
|
1
|
|
|
Yes
|
1.4 (1.1-1.8)
|
0.002**
|
Fever sinc week
|
No
|
1
|
|
|
Yes
|
2 (1.6-2.6)
|
< 0.001***
|
Table 2 presents the results of the univariate logistic regression analysis performed on the data of the cross-sectional survey in October 2016 in the two study areas. It was more likely to carry malaria parasite: in area with LLINs only compared to area with LLINs+IRS (OR = 4.2, 95%CI = 3.7—6.2) and in older children (> 5 years) compared to younger (OR = 1.6, 95%CI = 1.3–2.1). Having fever, anemia, and antecedent of fever in the previous two weeks were all positively associated with parasite carriage (Table 2). Children owing LLINs were at borderline of protection (OR = 0.6, 95%CI = 0.8–0.01; P = 0.0503) compared to those who didn’t.
Figure 3 shows results of the final stepwise multivariate regression model. Interactions between explanatory variables were assessed by including proper cross-product terms in the regression models. The likelihood ratio test was used compare model with and without the inter-action term to estimate the significance of the interaction. In this model LLINs was excluded from and we noticed an increase in the risk of parasite carriage and the study areas (OR adjusted = 5.6, p<0.0001). Children > 5 years old were twice likely (OR adjusted = 2.3, P <0.0001) to carry parasite compared to < 5 years old. The risk of infection associated with fever decreased (OR adjusted = 2), but was still significant (p = 0.028). Association between anemia and two weeks antecedent fever was not significant.
The overall incidence rate in children of 1–10 years was 2.7 for 100 person-month in LLLIs+IRS area and 6.8 for100 person-month in the area of LLINs-Only. However, during the first two months (July-August) and after the end of the rainy season (December—February), there was not a significant difference in malaria incidence between the two areas as shown in figure 4. It was from September to November that malaria incidence was significantly lower in LLINs+IRS area compared to the area of LLINs-only. As in malaria parasitemia, the peak of malaria incidence was observed in October in both areas but was much lower in the IRS area than the area without IRS.
The Kaplan Meier survival curve applied to the number of malaria episodes in children of 1–10 years old in each study area showed that children living in IRS area were more likely to be free of malaria (P < 0.001) than in the area without IRS (Figure 5).