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Background: In Senegal, malaria morbidity has shapely felt down over these past years. However, malaria epidemiology remains heterogeneous with persisting transmission in the southeastern part of the country and more important number of cases arising among older children and adolescents. Little is known about factors associated with clinical malaria among this group. A better understanding of malaria transmission among this new vulnerable group will guide future interventions targeting these key populations. This study aimed to identify factors associated with clinical malaria among adolescents in Senegal. Methods: A case control study was conducted from November to December 2020 in four health posts located in Saraya district. Cases were defined as adolescents (10-19 years) with uncomplicated malaria episode with fever (Temperature>37.5°) or history of fever and a positive malaria RDT. Controls were from the same age group, living in the neighborhood of the case, presenting a negative RDT. A standardized, pre-tested questionnaire was administered to each participant followed by home visit to assess participant’s living conditions. Factors associated with clinical malaria was assessed using a Stepwise Logistic regression analysis.Results: In total, 492 individuals were recruited (246 cases and 246 controls). In a multivariate analysis, factors associated with clinical malaria included non-use of bed net (aOR=2.65; 95% CI =1.58 - 4.45), non-use of other preventive measures (aOR=2.51; 95% CI=1.53 - 4.11) and indoor sleeping (aOR=3.22; 95%CI =1.66- 6.23). Protective factors included age of 15-19 years (aOR=0.38; 95% CI 0.23 - 0.62), absence of stagnant water around the house (aOR=0.27; 95% CI=0.16 - 0.44), having a female as head of household (aOR=0.47; 95% CI=0.25 - 0.90), occupation such as apprentice (OR=0.24; 95%CI=0.11 - 0.52).Conclusions: The study revealed that environmental factors and non-use of malaria preventive measures are the main determinant of malaria transmission among adolescents living in areas with persisting malaria transmission in Senegal. Strategies aiming at improving disease awareness and access to health care interventions such as LLIN are thus needed to improve malaria control and prevention among these vulnerable groups.

Background In Senegal, malaria morbidity has sharply decreased over these past years. However, malaria epidemiology remains heterogeneous with persistent transmission in the southeastern part of the country and many cases among older children and adolescents. Little is known about factors associated with clinical malaria among this group. A better understanding of malaria transmission among this newly emerging vulnerable group will guide future interventions targeting this population group. This study aimed to identify factors associated with clinical malaria among adolescents in Senegal. Methods A case–control study was conducted from November to December 2020 in four health posts located in the Saraya district. Cases were defined as adolescents (10–19 years) with an uncomplicated malaria episode with fever (temperature > 37.5°) or a history of fever and positive malaria rapid diagnostic test (RDT). Controls were from the same age group, living in the neighbourhood of the case, presenting a negative RDT. A standardized, pre-tested questionnaire was administered to each study participant followed by a home visit to assess the participant's living conditions. Factors associated with clinical malaria were assessed using stepwise logistic regression analysis. Results In total, 492 individuals were recruited (246 cases and 246 controls). In a multivariate analysis, factors associated with clinical malaria included non-use of long-lasting insecticidal net (LLIN) (aOR = 2.65; 95% CI 1.58–4.45), non-use of other preventive measures (aOR = 2.51; 95% CI 1.53–4.11) and indoor sleeping (aOR = 3.22; 95% CI 1.66–6.23). Protective factors included 15–19 years of age (aOR = 0.38; 95% CI 0.23–0.62), absence of stagnant water around the house (aOR = 0.27; 95% CI 0.16–0.44), having a female as head of household (aOR = 0.47; 95% CI 0.25–0.90), occupation such as apprentice (OR = 0.24; 95% CI 0.11–0.52). Conclusions The study revealed that environmental factors and non-use of malaria preventive measures are the main determinants of malaria transmission among adolescents living in areas with persistent malaria transmission in Senegal. Strategies aimed at improving disease awareness and access to healthcare interventions, such as LLINs, are needed to improve malaria control and prevention among these vulnerable groups.

Background: Seasonal malaria chemoprevention (SMC) with sulfadoxine-pyrimethamine plus amodiaquine (SPAQ) is a malaria prevention strategy recommended since 2012 by the World Health Organization (WHO) for children under 5 years. In Senegal, the scaling up of SMC started in 2013 in the south-eastern regions of the country with an extension of the target to 10 years old children. The scaling up of SMC requires regular evaluation of the strategy as recommended by the WHO. This study was conducted to evaluate the effectiveness of SMC. Methods: A case-control study was conducted in some villages of the health districts of Saraya and Kedougou in the Kedougou region from July to December 2016. A case was a sick child, aged 3 months to 10 years, seen in consultation and with a positive malaria rapid diagnostic test (RDT). The control was a child of the same age group with a negative RDT and living in the same compound as the case or in a neighbouring compound. Each case was matched with two controls. Exposure to SMC was assessed by interviewing the mothers/caretakers and by checking the SMC administration card. Results: Overall, 492 children, including 164 cases and 328 controls, were recruited in our study. Their mean ages were 5.32 (+/- 2.15) and 4.44 (+/-2.25) years for cases and controls, respectively. The number of boys was higher in both cases (55.49%; CI 95%=47.54-63.24%) and controls (51,22%; CI 95%=45.83-56.58%). Net ownership was 85.80% among cases and 90.85% among controls (p=0,053). The proportion of controls who received SMC was higher than that of cases (98.17% vs 85.98% and p=1.10-7). The protective effectiveness of SMC was 89% (OR= 0.12 (CI 95%=0.04-0.28)). Conclusions: SMC is an effective strategy in the control of malaria in children. Case-control studies are a good approach for monitoring the efficacy of drugs administered during SMC.

Dans les districts sanitaires de Mbour, Fatick, Niakhar et Bambey, situes au centre-ouest du Senegal, l’utilisation de mesures de lutte efficaces a fait fortement baisser l’incidence du paludisme qui n’est actuellement sensible que dans des foyers residuels de transmission encore appeles hotspots. Cette etude fait le point sur la place des gites larvaires d’anophele dans la selection des hotspots dans cette partie du Senegal. Les prospections des gites larvaires ont ete faites dans 6 villages hotspots et 4 villages non hotspots. Un prelevement a ete effectue dans chaque point d’eau presentant des larves de moustiques par la methode de dipping et les specimens collectes ont ete identifies au niveau genre. Des parametres complementaires ont ete aussi releves: nom du village et du gite, type de collection, origine de l’eau, turbidite, presence de vegetation, la proximite des habitations, coordonnees geographiques, dimensions. Au total soixantedeux stations ont ete prospectees et surveillees entre 2013 et 2014. Les gites naturels temporaires ont ete predominants quel que soit le statut epidemiologique du village. Sur les 31 gites situes a moins de 500 metres des habitations dans les villages hotspots, 70 % etaient positifs en larves d’anopheles en milieu de saison des pluies alors que 43 % des 21 gites situes a des distances similaires dans les villages non hotspots etaient positifs pendant la meme periode (P=0,042

Resume La regression de l’endemie palustre constatee dans certaines zones au centre du Senegal laisse entrevoir l’espoir d’une elimination de cette pathologie qui constitue un lourd fardeau en termes de morbidite et de mortalite. En effet dans les districts de Mbour, Fatick, Niakhar et Bambey, situes au centre-ouest du Senegal, le paludisme evolue en foyers de transmissions residuelles (hot spots) suite aux efforts de lutte realises ces dernieres annees. Le but de cet essai d’elimination est de mener une lutte intensifiee et ciblee sur les hot spots en utilisant des strategies a efficacite prouvee a savoir l’aspersion intradomiciliaire (AID) d’insecticide a effet remanent et la chimio prevention. L’AID est une intervention tres lourde dans sa mise en oeuvre et necessite une grande adhesion des populations. Apres sa mise en oeuvre en aout 2013 au niveau de 4 districts du centre-ouest du Senegal, une enquete d’acceptabilite de l’intervention a ete realisee sur un echantillon aleatoire de 370 menages. Les resultats de cette enquete ont revele une bonne acceptabilite de l’intervention avec 97,8 % des personnes interrogees qui jugent que l’AID est bien et meme excellente pour la communaute. Malgre les desagrements que peuvent engendrer cette activite, notamment la preparation des structures a traiter, 98 % des personnes interrogees estiment ne pas avoir ete perturbees dans leurs activites quotidiennes. Le comportement des applicateurs a ete juge exemplaire et professionnel par 98,6 % de l’echantillon de menages et la quasi-totalite (99,7 %) accepteraient que leurs structures soient traitees a nouveau l’annee suivante. Sur le plan pratique, la pulverisation avec l’Actellic ® 300 CS (pirimiphos-methyl, organophosphore) n’a pas occasionne de problemes majeurs aux populations beneficiaires. Au final, nous avons constate une grande satisfaction de la population des villages traites, en particulier en raison d’une forte reduction des nuisances causees par les insectes.

In 1998, folic acid fortification of a large variety of cereal products became mandatory in Canada, a country where the prevalence of neural-tube defects was historically higher in the eastern provinces than in the western provinces. We assessed changes in the prevalence of neural-tube defects in Canada before and after food fortification with folic acid was implemented.The study population included live births, stillbirths, and terminations of pregnancies because of fetal anomalies among women residing in seven Canadian provinces from 1993 to 2002. On the basis of published results of testing of red-cell folate levels, the study period was divided into prefortification, partial-fortification, and full-fortification periods. We evaluated the relationship between baseline rates of neural-tube defects in each province and the magnitude of the decrease after fortification was implemented.A total of 2446 subjects with neural-tube defects were recorded among 1.9 million births. The prevalence of neural-tube defects decreased from 1.58 per 1000 births before fortification to 0.86 per 1000 births during the full-fortification period, a 46% reduction (95% confidence interval, 40 to 51). The magnitude of the decrease was proportional to the prefortification baseline rate in each province, and geographical differences almost disappeared after fortification began. The observed reduction in rate was greater for spina bifida (a decrease of 53%) than for anencephaly and encephalocele (decreases of 38% and 31%, respectively).Food fortification with folic acid was associated with a significant reduction in the rate of neural-tube defects in Canada. The decrease was greatest in areas in which the baseline rate was high.

BACKGROUND: In 1998, fortification of a large variety of cereal products with folic acid became mandatory in Canada. A multicentric study was carried out to assess the impact of this policy on the frequency of NTDs. The present analysis focused on spina bifida. METHODS: The study population included approximately 2 million livebirths, stillbirths, and terminations of pregnancies because of fetal anomalies among women residing in seven Canadian provinces, from 1993 to 2002. Spina bifida cases were divided according to the upper limit of the defect: upper (cranial, cervical, or thoracic) and lower (lumbar or sacral) defects. Based on published results of red blood cell folate tests, the study period was divided into prefortification, partial fortification, and full fortification periods. RESULTS: A total of 1,286 spina bifida cases were identified: 51% livebirths, 3% stillbirths, and 46% terminations. Prevalence decreased from 0.86/1,000 in the prefortification to 0.40 in the full fortification period, while the proportion of upper defects decreased from 32% to 13%. Following fortification, regional variations in the prevalence and distribution of sites almost disappeared. CONCLUSIONS: Results confirmed the etiologic heterogeneity of spina bifida and the more pronounced effect of folic acid in decreasing the risk of the more severe clinical presentations. Birth Defects Research (Part A) 2008. © 2008 Wiley-Liss, Inc.

BACKGROUND: Recent studies reported no reduction in the frequency of lipomeningomyelocele (LMMC) in Hawaii and Nova Scotia after the implementation of a folic acid food fortification policy in 1998, while a marked reduction in the prevalence of other NTDs was observed. This study was performed to assess the prevalence of LMMC in Canada in relation to the timing of food fortification. METHODS: The study population included livebirths, stillbirths, and terminations of pregnancies because of fetal anomaly to women residing in seven Canadian provinces, from 1993 to 2002. In each province, the ascertainment of NTD cases relied on multiple sources, and in addition all medical charts were reviewed. The study period was divided into pre-, partial, and full fortification periods, based on results of red cell folate tests published in the literature. RESULTS: A total of 86 LMMC cases were recorded among approximately 1.9 million live births. The average birth prevalence rate was 0.05/1,000, ranging from a minimum of 0.01/1,000 in 2002 to a maximum of 0.08/1,000 in 1999. There was statistical heterogeneity between years (p = .01), but no pattern compatible with a decrease following fortification. Comparing the full fortification period with the prefortification period, there was a slight but not statistically significant decrease in LMMC birth prevalence. CONCLUSIONS: LMMC seems to be pathogenically distinct from myelomeningocele and more studies are needed to understand the embryologic mechanisms leading to this condition, and the environmental and genetic factors involved in its etiology. Birth Defects Research (Part A), 2008. © 2007 Wiley-Liss, Inc.

The objectives of this study were 1) to assess the validity of different databases which identify neural tube defect (NTD) cases in the population, and 2) to examine the temporal trends in NTD rates and the impact of prenatal diagnoses among pregnancies referred to a tertiary care hospital in Quebec City, Canada, from 1993 to 2002. Infant death and stillbirth certificates were a highly reliable source for ascertaining NTD cases, but their overall sensitivity was poor (13 percent). Med-Echo had very good sensitivity (92 percent), but there were many coding errors in the database and some diagnostic categories were not specific for NTD. The average NTD prevalence proportion was 6.5/1,000 births during the entire study period, decreasing from 12.2/1,000 in 1993 to 3.9/1,000 in 2002. Overall, 78.6 percent of NTD cases were diagnosed prenatally and the pregnancy was terminated in 52.6 percent of these. These two proportions were stable over the study years. To conclude, the combination of hospital discharge summaries and infant death and stillbirth certificates is a highly sensitive method for the ascertainment of NTD cases, including terminations of pregnancies, but medical records must be reviewed to exclude coding errors and to clarify unspecific diagnostic categories.