Gallalee Sarah, Kande Demba, Thiam Tidiane, Ntuku Henry, Guinovart Caterina, Merriman Laura, Sall Abiboulaye, Cissé Moustapha, Barry Diouf Aichatou, Diop Mamadou, Camara Baba, Seck Niene, De Amaral Faith, Gosling Roly, Greenhouse Bryan, Dieye Yakou, Smith Jennifer, Bennett Adam
Malaria Elimination Initiative, Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, United States of America.
PATH Malaria Control and Elimination Partnership in Africa, Dakar, Senegal.
PLOS Glob Public Health. 2025 Apr 29;5(4):e0004569. doi: 10.1371/journal.pgph.0004569. eCollection 2025.
Senegal has made significant progress in reducing the malaria burden over the last decade. However, malaria remains a major cause of morbidity in some regions and key challenges exist among high-risk populations who have high exposure to mosquitos, but low coverage and use of vector control measures and limited access to healthcare. Two identified high-risk populations are goldminers and talibés (Koranic school students). We conducted a controlled pre/post survey to measure the impact of targeted malaria interventions, including expansion of active community case management and distribution of LLINs, on reported LLIN usage and Plasmodium falciparum infection prevalence at mining sites and Koranic schools (daaras) during the high transmission season in Senegal. We randomly assigned four health facility catchment areas in Kaolack (a city with many daaras) and four in Saraya (a district with gold mining sites) to intervention or control groups. Surveys were conducted pre (Oct 2021; n = 1740 talibés and gold miners) and post (Feb 2022; n = 2200) delivery of the intervention package to assess intervention coverage and infection prevalence by rapid diagnostic test and qPCR. We compared infection prevalence and self-reported LLIN usage, by group and arm, between the two time periods using a difference in difference framework with binomial generalized linear mixed models. Among the talibés, the package of interventions was associated with an adjusted 12.6-percentage point relative reduction in RDT-derived malaria prevalence (p < 0.05, adjusted risk difference: -12.6, 95% CI: -2.7, -22.4) and an adjusted 44.0-percentage point increase in reported prior night net use (p < 0.001, aRD: 44.0, 95% CI: 36.3, 51.6) in the intervention group compared to the counterfactual. However, among the gold miners there was no measured association between the package of interventions and these outcomes. While there was high acceptability in both groups, interventions should be tailored to address high mobility amongst gold miners and maximize impact.
在过去十年中，塞内加尔在减轻疟疾负担方面取得了重大进展。然而，疟疾在一些地区仍是发病的主要原因，在高风险人群中存在关键挑战，这些人群接触蚊子的机会多，但病媒控制措施的覆盖率和使用率低，获得医疗保健的机会有限。已确定的两个高风险人群是金矿工人和塔里贝斯（古兰经学校学生）。我们进行了一项对照前后调查，以衡量有针对性的疟疾干预措施的影响，包括扩大积极的社区病例管理和分发长效驱虫蚊帐，对塞内加尔高传播季节期间矿区和古兰经学校（达阿拉斯）报告的长效驱虫蚊帐使用率和恶性疟原虫感染率的影响。我们将考拉克（一个有许多达阿拉斯的城市）的四个卫生设施集水区和萨拉亚（一个有金矿的地区）的四个卫生设施集水区随机分配到干预组或对照组。在干预措施包发放前（2021年10月；n = 1740名塔里贝斯和金矿工人）和发放后（2022年2月；n = 2200）进行调查，通过快速诊断测试和定量聚合酶链反应评估干预措施的覆盖率和感染率。我们使用二项广义线性混合模型的差异中的差异框架，比较了两个时间段内按组和臂划分的感染率和自我报告的长效驱虫蚊帐使用率。在塔里贝斯人群中，与对照组相比，干预措施包使基于快速诊断测试得出的疟疾感染率相对降低了12.6个百分点（p < 0.05，调整后的风险差异：-12.6，95%可信区间：-2.7，-22.4），并使报告的前一晚蚊帐使用率提高了44.0个百分点（p < 0.001，调整后的风险差异：44.0，95%可信区间：36.3，51.6）。然而，在金矿工人中，干预措施包与这些结果之间没有测量到关联。虽然两组的接受度都很高，但干预措施应进行调整，以应对金矿工人的高流动性并最大限度地提高影响。
