Progress in the control of malaria in Guinea

Abstract

Guinea has made tremendous progress in its fight against malaria. Most of this progress is due to Guinea’s leadership and commitment to scale-up key malaria interventions, backed by substantial external financial support such as the Global Fund to Fight AIDS, Tuberculosis and Malaria and the President’s Malaria Initiative (PMI). PMI’s main platform from 2013 onwards has been the USAID Guinea StopPalu project, which has been operational in 19 of the country’s 38 districts. The project supported Guinea’s National Malaria Control Program in the distribution of long-lasting insecticidal nets, training of health care workers in malaria case management, strengthening community engagement at different levels, and the integration of malaria services between the public and private sector. We analyzed temporal and spatial changes in the malaria rest positivity rate to assess changes in the malaria burden in the project’s 19 districts from 2014–2017. Analyses were performed on routine monthly data from 141 public and private facilities and stored in a District Health Information System 2 (DHIS2) project database. Generalized additive mixed models were used to describe the temporal trend of the test positivity rate. Spatial analyses were applied to identify malarial fever hot-spots every year; space-time Bayesian models were applied to produce maps to estimate the spatial pattern of malarial fever fraction from 2014–2017. Trend analyses highlighted that the test positivity rate had a strong seasonality and was significantly reduced by 34.5% from 79.1% in 2014 to 52.3% in 2017. This reduction mostly affected children under 5 years of age but was also evident in other age groups. The analyses also showed that the test positivity rate had a marked spatial heterogeneity, with a rapid decrease in malaria fevers shown in northern Guinea. These findings corroborate prevalence data on children under 5 years of age from the country’s 2016 Demographic and Health Survey. Developed maps could be used by Guinea’s national program to target interventions to those areas with continued high malaria transmission.