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BURDEN OF MALARIA AT COMMUNITY LEVEL IN CHILDREN LESS THAN 5 YEARS OF AGE IN TOGO

A community-based baseline cross-sectional survey was conducted in three districts in Togo in September 2004 as part of a multidisciplinary evaluation of the impact of the Togo National Integrated Child Health Campaign. During this campaign, long-lasting-insecticide-treated bed nets (LLITNs) were distributed to households with children between 9 months and 5 years of age throughout the country in December 2004. The pre-intervention survey provided baseline malaria and anemia prevalence in children < 5 years of age during peak malaria transmission. Of 2,532 enrolled children from 1,740 households, 62.2% (1,352/2,172) were parasitemic and 84.4% (2,129/2,524) were anemic (hemoglobin < 11 g/dL). Moderate-to-severe anemia (< 8.0 g/dL) was found in 21.7% (543/2,524), with a peak prevalence in children 6–17 months of age and was strongly correlated with parasitemia (OR = 2.3, 95% CI: 1.8–2.5). Net ownership (mainly untreated) was 225/2,532 (8.9%). Subsequent nation-wide introduction of LLITNs and the introduction of artemisinin-based combination therapy have the potential to markedly reduce this burden of malaria.

Received January 18, 2006. Accepted for publication June 11, 2006.

Acknowledgments: We are grateful to the parents and guardians of the children who participated in the survey and the many people that assisted with this project. We thank Dr. Potougnima Tchamdja from the MoH Togo, Norbert Paniah, Antoinette Awaga, Blaise Edoh, and Messan Nyonato from the Togolese Red Cross, Bart Peeters and Chris Weeks from DHL, and Phillip Brun from Sanofi-Synthelabo for logistical support. At the International Federation of the Red Cross and Red Crescent Society, the authors thank Nick Farrell, Jean Roy, and Bernard Moriniere for assistance, and at the Canadian Red Cross, Marcy Erskine and Mel Peters. We are grateful to Anatoly Frolov for programming the PDA-GPS–related software. From WHO, the authors thank Bernard Nahlen and John Miller for critically reviewing the questionnaire.

Financial support: This survey was funded by Canadian Red Cross. Arsucam, the anti-malarial drug used in the survey, was kindly donated by Sanofi-Synthelabo in France. DHL donated their assistance with the transportations of study shipment. Dr. Terlouw acknowledges financial support from the Canadian Red Cross.

Disclaimer: The opinions or assertions contained in this manuscript are the private ones of the authors and are not to be construed as official or reflecting the view of the US Public Health Service or Department of Health and Human Services. Use of trade names is for identification only and does not imply endorsement by the US Public Health Service or Department of Health and Human Services.

^* Address correspondence to M. James Eliades, Centers for Disease Control and Prevention, 4770 Buford Highway, MS F-22, Atlanta, GA 30341. E-mail: bvz9{at}cdc.gov

Authors’ addresses: M. James Eliades, Adam Wolkon, Sara B. Crawford, William A. Hawley, and Allen W. Hightower, Centers for Disease Control and Prevention, 4770 Buford Highway, MS F-22, Atlanta, GA 30341. Kodjo Morgah, Ameyo Dorkenoo, and Yao Sodahlon, Programme National de Lutte contre le Paludisme (PNLP), BP518, Lome, Togo. Feiko O. Ter Kuile and Dianne J. Terlouw, Child & Reproductive Health Group, Liverpool School of Tropical Medicine, Pembroke Place, L3 5QA Liverpool, UK.

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