Malaria Burden and Associated Risk Factors in an Area of Pyrethroid-Resistant Vectors in Southern Benin

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  • 1 Faculty of Infectious and Tropical Diseases, Disease Control Department, London School of Hygiene and Tropical Medicine, London, United Kingdom;
  • | 2 Centre de Recherche Entomologique de Cotonou (CREC), Cotonou, Benin;
  • | 3 UER Parasitology Mycology, Health Science Faculty, Abomey-Calavi University; National Malaria Control Program, Ministry of Health, Cotonou, Benin;
  • | 4 School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada;
  • | 5 Medical Research Council (MRC) International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom

Malaria remains the main cause of morbidity and mortality in Benin despite the scale-up of long-lasting insecticidal nets (LLINs), indoor residual spraying, and malaria case management. This study aimed to determine the malaria burden and its associated risk factors in a rural area of Benin characterized by high net coverage and pyrethroid-resistant mosquito vectors. A community-based cross-sectional survey was conducted in three districts in southern Benin. Approximately 4,320 randomly selected participants of all ages were tested for malaria using rapid diagnostic tests within 60 clusters. Risk factors for malaria infection were evaluated using mixed-effect logistic regression models. Despite high population net use (96%), malaria infection prevalence was 43.5% (cluster range: 15.1–72.7%). Children (58.7%) were more likely to be infected than adults (31.2%), with a higher malaria prevalence among older children (5–10 years: 69.1%; 10–15 years: 67.9%) compared with young children (< 5 years: 42.1%); however, young children were more likely to be symptomatic. High household density, low socioeconomic status, young age (< 15 years), poor net conditions, and low net usage during the previous week were significantly associated with malaria infection. Malaria prevalence remains high in this area of intense pyrethroid resistance despite high net use. New classes of LLINs effective against resistant vectors are therefore crucial to further reduce malaria in this area.

Author Notes

Address correspondence to Manfred Accrombessi, Faculty of Infectious and Tropical Diseases, Disease Control Department, London School of Hygiene and Tropical Medicine, WC1E 7HT, London, United Kingdom. E-mail: manfred.accrombessi@lshtm.ac.uk

Financial support: This research was supported by a grant to the London School of Hygiene and Tropical Medicine from UNITAID and Global Fund via the Innovative Vector Control Consortium (IVCC). The funders do not play a role in study design, collection, management, analysis, and interpretation of data. They did not influence the writing of the report and the decision to submit it.

Authors’ addresses: Manfred Accrombessi, Arthur Sovi, Mark Rowland, Corine Ngufor, and Natacha Protopopoff, Faculty of Infectious and Tropical Diseases, Disease Control Department, London School of Hygiene and Tropical Medicine, London, United Kingdom, E-mails: manfred.accrombessi@lshtm.ac.uk, arthur.sovi@lshtm.ac.uk, mark.rowland@lshtm.ac.uk, corine.ngufor@lshtm.ac.uk, and natacha.protopopoff@lshtm.ac.uk. Martin C. Akogbeto, Edouard Dangbenon, Hilaire Akpovi, Boulais Yovogan, Constantin Adoha, Landry Assongba, and Germain Gil Padonou, Centre de Recherche Entomologique de Cotonou (CREC), Cotonou, Benin, E-mails: akogbetom@yahoo.fr, dangbenonedouard@gmail.com, hakpovi95@yahoo.fr, yobousy@yahoo.fr, adohaj.constantin@yahoo.fr, assolandry@yahoo.fr, and pagergil@yahoo.fr. Aurore Ogouyemi-Hounto, UER Parasitology Mycology, Health Science Faculty, Abomey-Calavi University; National Malaria Control Program, Ministry of Health, Cotonou, Benin, E-mail: aurorfel@yahoo.fr. Charles Thickstun, School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada, E-mail: cthickstun@gmail.com. Jackie Cook, Medical Research Council (MRC) International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom, E-mail: jackie.cook@lshtm.ac.uk.

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