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Objective To investigate if the first national insecticide-treated bed-net campaign in Burkina Faso, done in 2010, was followed by a decrease in childhood malaria in a district with high baseline transmission of the disease. Methods We obtained data on the prevalence of Plasmodium falciparum parasitaemia in children aged 2 weeks to 36 months from malaria surveys in 2009 and 2011. We assessed morbidity in children younger than 5 years by comparing data from the Nouna health district's health management information system before and after the campaign in 2010. We analysed mortality data from 2008 to 2012 from Nouna's health and demographic surveillance system. Findings The bed-net campaign was associated with an increase in the reported use of insecticide-treated nets. In 2009,73% (630/869) of children reportedly slept under nets. In 2011, 92% (449/487) did. The campaign had no effect on the proportion of young children with P. falciparum parasitaemia after the rainy season; 52% (442/858) in 2009 and 53% (263/499) in 2011. Cases of malaria increased markedly after the campaign, as did the number of children presenting with other diseases. The campaign was not associated with any changes in child mortality. Conclusion The 2010 insecticide-treated net campaign in Burkina Faso was not associated with a decrease in care-seeking for malaria or all-cause mortality in children younger than 5 years. The most likely explanation is the high coverage of nets in the study area before the campaign which could have had an effect on mosquito vectors, limiting the campaign's impact. [TEXT NOT REPRODUCIBLE IN ASCII] Objectif Etudier si la premiere campagne nationale visant a utiliser des moustiquaires impregnees d'insecticide au Burkina Faso, menee en 2010, a ete suivie d'une baisse des cas de paludisme infantile dans un district ayant un taux eleve de transmission de la maladie. Methodes Nous nous sommes procure des donnees sur la prevalence de la parasitemie de Plasmodium falciparum chez les enfants ages de 2 semaines a 36 mois a partir des enquetes sur le paludisme menees en 2009 et 2011. Nous avons evalue la morbidite chez les enfants de moins de 5 ans en comparant les donnees du systeme d'information sanitaire du district de Nouna avant et apres la campagne de 2010. Nous avons analyse les donnees sur la mortalite de 2008 a 2012 provenant du systeme de surveillance sanitaire et demographique de Nouna. Resultats La campagne pour l'utilisation de moustiquaires a ete associee a une augmentation de l'utilisation de moustiquaires impregnees d'insecticide. En 2009, d'apres l'enquete menee, 73% des enfants (630/869) dormaient sous une moustiquaire. En 2011, ils etaient 92% (449/487). La campagne n'a pas eu d'effet sur la proportion de jeunes enfants presentant une parasitemie de P falciparum apres la saison des pluies: ils etaient 52% (442/858) en 2009 et 53% (263/499) en 2011. Les cas de paludisme ont sensiblement augmente apres la campagne, comme le nombre d'enfants atteints d'autres maladies. La campagne n'etait associee a aucun changement de la mortalite infantile. Conclusion La campagne de 2010 pour l'utilisation de moustiquaires impregnees d'insecticide au Burkina Faso n'a pas ete associee a une diminution des consultations pour paludisme ou de la mortalite, toutes causes confondues, chez les enfants de moins de 5 ans. L'explication la plus probable est liee au taux eleve d'utilisation de moustiquaires dans la zone etudiee avant la campagne, qui pourrait avoir eu un effet sur les moustiques vecteurs de la maladie et avoir limite l'impact de la campagne. [TEXT NOT REPRODUCIBLE IN ASCII] Objetivo Investigar si la primera campana nacional de mosquiteros tratados con insecticida en Burkina Faso, que se llevo a cabo en 2010, tuvo como resultado un descenso del paludismo infantil en un distrito con una referencia elevada de transmision de la enfermedad. Metodos Se obtuvieron datos sobre la prevalencia de parasitemia por Plasmodium falciparum en ninos de edad entre las 2 semanas y los 36 meses de encuestas sobre la malaria de 2009 y 2011. Se evaluo la morbilidad en ninos menores de 5 anos mediante la comparacion de los datos del sistema de gestion de Informacion sanitaria del departamento de salud de Nouna antes y despues de la campana de 2010. Se analizaron los datos de mortalidad desde 2008 hasta 2012 del sistema de vigilancia sanitaria y demografica de Nouna. Resultados La campana de distribucion de mosquiteros se relaciono con un aparente aumento del uso de redes tratadas con insecticida. En 2009, aparentemente el 73% (630/869) de los ninos dormia bajo mosquiteros. En 2011, lo hacia el 92% (449/487). La campana no tuvo efecto en la proporcion de ninos pequenos con parasitemia por R falciparum despues de la temporada de lluvias; el 52% (442/858) en 2009 y el 53% (263/499) en 2011. Los casos de malaria aumentaron notablemente despues de la campana, igual que lo hizo el numero de ninos que mostraban otras enfermedades. La campana no se relaciono con ningun cambio en la mortalidad Infantil. Conclusion La campana de distribucion de mosquiteros tratados con Insecticida realizada en 2010 en Burkina Faso no estuvo relacionada con un descenso en la atencion medica relacionada con la malaria o la mortalidad a causa de la misma en ninos menores de 5 anos. La explicacion mas logica es la gran cobertura de redes en el area del estudio antes de la campana, lo que podria haber tenido un efecto en los mosquitos vectores, limitando el impacto de la campana., Introduction Malaria remains a major threat to the health of some three billion people in 108 countries where the disease is endemic. (1) According to the World Health Organization (WHO), [...]

Abstract Background Roll Back Malaria (RBM) interventions such as insecticide-treated mosquito nets (ITN) and artemisinin-based combination therapy (ACT) have become implemented with different velocities in the endemic countries of sub-Saharan Africa (SSA) in recent years. There is conflicting evidence on how much can be achieved under real life conditions with the current interventions in the highly endemic savannah areas of SSA. Methods The study took place in a rural area of north-western Burkina Faso, which was defined as holoendemic in 1999. Clinical and parasitological data were compared in two cohorts of young children of the same age range from eight villages. Surveys took place in June and December of the year 1999 and 2009 respectively. Results Prevalence of mosquito net use increased from 22% in 1999 to 73% in 2009, with the majority of nets being ITNs in 2009. In 2009, P. falciparum prevalence was significantly lower compared to 1999 (overall reduction of 22.8%). Conclusions The reduction in malaria prevalence in young children observed between 1999 and 2009 in a rural and formerly malaria holoendemic area of Burkina Faso is likely attributable to the increase in ITN availability and utilization over time.

Abstract Background Insecticide-treated nets (ITNs) have been confirmed to be a very effective tool in malaria control. Two different delivery strategies for roll-out of ITN programmes have been the focus of debate in the last years: free distribution and distribution through commercial marketing systems. They are now seen as complementary rather than opponent. Acceptance of these programmes by the community and involved providers is an important aspect influencing their sustainability. This paper looks at how providers perceived, understood and accepted two interventions involving two different delivery strategies (subsidized sales supported by social marketing and free distribution to pregnant women attending antenatal care services). Methods The interventions took place in one province of north-western Burkina Faso in 2006 in the frame of a large randomized controlled ITN intervention study. For this descriptive qualitative study data were collected through focus group discussions and individual interviews. A total of four focus group discussions and eleven individual interviews have been conducted with the providers of the study interventions. Results The free distribution intervention was well accepted and perceived as running well. The health care staff had a positive and beneficial view of the intervention and did not feel overwhelmed by the additional workload. The social marketing intervention was also seen as positive by the rural shopkeepers. However, working in market economy, shopkeepers feared the risk of unsold ITNs, due to the low demand and capacity to pay for the product in the community. Conclusion The combination of ITN free distribution and social marketing was in general well accepted by the different providers. However, low purchasing power of clients and the resulting financial insecurities of shopkeepers remain a challenge to ITN social marketing in rural SSA.

Abstract Background Effective and timely treatment is an essential aspect of malaria control, but remains a challenge in many parts of sub-Saharan Africa. The objective of this study was to describe young children's access to malaria treatment in Nouna Health District, Burkina Faso. Methods In February/March 2006, a survey was conducted in a representative sample of 1,052 households. Results Overall 149/1052 (14%) households reported the current possession of anti-malarial medicine, which was significantly associated with urban area, literacy of household head, having young children, and high socio-economic status. Out of a total of 802 children under five years, at least one malaria episode was reported for 239 (30%) within the last month. Overall 95% of children received treatment, either modern (72%), traditional (18%) or mixed (5%). Most of the medicines were provided as home treatment by the caregiver and half of children received some type of modern treatment within 24 hours of the occurrence of first symptoms. Despite a recent policy change to artemisinin-based combination therapy, modern anti-malarials consisted mainly of chloroquine (93%). Modern drugs were obtained more often from a health facility in localities with a health facility compared to those without (60% vs. 25.6%, p < 0.001). In contrast, beside informal providers, volunteer community health workers (CHW) were the main source of modern medicine in localities without a health centre (28% vs. 3%, p < 0.001). Conclusion Access to modern health services providing quality controlled effective combination therapies against malaria needs to be strengthened in rural Africa, which should include a re-investigation of the role of CHW 30 years after Alma Ata.

Abstract Background The literature on health care seeking behaviour in sub-Saharan Africa for children suffering from malaria is quite extensive. This literature, however, is predominately quantitative and, inevitably, fails to explore how the local concepts of illness may affect people's choices. Understanding local concepts of illness and their influence on health care-seeking behaviour can complement existing knowledge and lead to the development of more effective malaria control interventions. Methods In a rural area of Burkina Faso, four local concepts of illness resembling the biomedical picture of malaria were described according to symptoms, aetiology, and treatment. Data were collected through eight focus group discussions, 17 semi-structured interviews with key informants, and through the analysis of 100 verbal autopsy questionnaires of children under-five diagnosed with malaria. Results Sumaya, dusukun yelema, kono, and djoliban were identified as the four main local illness concepts resembling respectively uncomplicated malaria, respiratory distress syndrome, cerebral malaria, and severe anaemia. The local disease categorization was found to affect both treatment and provider choice. While sumaya is usually treated by a mix of traditional and modern methods, dusukun yelema and kono are preferably treated by traditional healers, and djoliban is preferably treated in modern health facilities. Besides the conceptualization of illness, poverty was found to be another important influencing factor of health care-seeking behaviour. Conclusion The findings complement previous evidence on health care-seeking behaviour, by showing how local concepts of illness strongly influence treatment and choice of provider. Local concepts of illness need to be considered when developing specific malaria control programmes.