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Dynamics of Trypanosome Infections in Borgou Cattle at the Okpara Ranch in Benin. The dynamics of trypanosome infections have been studied over a period of 12 months in 55 Borgou cattle at the Okpara ranch of which 5 adult bulls, 20 young males and 30 calves. Moderate and temporary weight losses were observed both in infected and uninfected animals which indicates that these are not directly linked to trypanosome infections. Based on parasitological examinations the cumulative infection level reached 95% in young males and 80% in adult bulls, which is much higher than in calves (30%). The results show that the critical age for infection at the ranch is between 1 and 3 years old. These high infection levels indicate the occurrence of infected tsetse flies on the ranch. Therefore, the choice of trypanotolerant cattle is fully justified. Given the fact that the infection level of the calves remains zero until seven months of age and reaches only 3% at 8 months, the systematic trypanocidal treatments which are currently given to 2 month old calves have only a marginal benefit.

Background: Rectal prolapse is a public health problem that affects all sexes at different ages. It is one of the most frequent reasons for consultation in pediatric surgery. The main causes are chronic constipation and diarrhea or both. The increase in abdominal pressure, whatever its cause, is an essential factor favoring the occurrence of rectal prolapse. The anatomical factors related to the morphology of the pelvis and sacrum are unknown. The objective of this work was to compare the morphometric variations of the pelvis in children aged from 0 to 15 years with and without rectal prolapse. Methods: This was a case-control study of 128 children (64 males) living in Niger, children without rectal prolapse (controls) were paired to those with rectal prolapse by age for both sexes. Morphometric parameters were measured on computed tomography scans. The length, concavity and slope of the sacrum were measured. Antero-posterior, bi-ischiatic, and sub-sacro-sub-pubic diameters were measured on the pelvis. Results: In girls and boys with rectal prolapse, with the generalized linear model the sacral length was significantly increased with p = 0.0005 and sacral concavity decreased as compared with controls with p = 0.0007. The sacral slope has probably also an effect but impaired by large variations. There were no significant changes in other pelvic parameters. Conclusion: The morphology of the sacrum is an anatomical factor probably related to the occurrence of rectal prolapse in children.

Byline: C. F. A. Salifou, M. Dahouda, G. S. Ahounou, S. K. Kassa, P. U. Tougan, S. Farougou, G. A. Mensah, S. Salifou, A. Clinquart and A. K. I. Youssao [...]

Intense transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Africa might promote emergence of variants. We describe 10 SARS-CoV-2 lineages in Benin during early 2021 that harbored mutations associated with variants of concern. Benin-derived SARS-CoV-2 strains were more efficiently neutralized by antibodies derived from vaccinees than patients, warranting accelerated vaccination in Africa.

Background: Having a maximum number of people vaccinated was the objective to control the COVID-19 pandemic. We report in this manuscript the factors associated with the willingness to be vaccinated against COVID-19 during the pandemic period. Methods: From April to May 2022, a community-based cross-sectional survey was performed. Participants were randomly selected from four districts in Benin (taking into account the COVID-19 prevalence). Mixed-effect logistic regression models were used to identify the variables associated with COVID-19 vaccine acceptance. Results: A total of 2069 participants were included. The proportion of vaccine acceptance was 43.3%. A total of 24.2% were vaccinated and showed proof of vaccination. The population’s request for vaccination was higher after the third epidemic wave. The district of residence, the education level, a fear of being infected, the channel of information, poor medical conditions, a good knowledge of the transmission mode and symptoms, and good behaviors were significantly associated with vaccine acceptance. Conclusion: The overall acceptance of the COVID-19 vaccine in the Beninese population was relatively high. However, vaccine campaigns in areas with a low acceptance as well as the disclosure of information, particularly on our knowledge of the disease and the safety, side effects, and effectiveness of the COVID-19 vaccines, should be strengthened with adapted and consistent messages.

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La relation entre mobilité et extension urbaine a donné naissance à plusieurs modèles de ville. Les pratiques d’aménagement, fortement dépendantes de l’automobile, ont participé au processus d’étalement urbain caractéristique des pays du nord. Ce modèle observé également dans les capitales africaines repose toutefois sur des modes de déplacements très variés, sources d’une grande vulnérabilité pour les usagers et d’un nombre élevé de traumatismes issus des accidents de la route. Cet article vise à comprendre en quoi l’aménagement urbain participe de cette vulnérabilité dans la capitale du Burkina Faso, Ouagadougou. L’étude repose sur la géolocalisation des lieux d’accidents et des entrevues réalisées auprès des acteurs communaux. Les résultats montrent un lien fort entre étalement urbain et importance des accidents de la route de façon originale puisqu’ils sont caractéristiques des axes revêtus. Le développement de l’habitat est au coeur des politiques urbaines, la question de la mobilité est beaucoup plus récente, imposée par la croissance démographique. Cependant, la politique des transports en commun reste embryonnaire, le moyen de déplacement privilégié est le deux roues. Le pouvoir local ne semble pas avoir pour vocation de protéger les populations vulnérables en circulation, la valeur dominante en matière de conception du réseau routier reposant sous la garantie d’une mobilité toujours plus fluide et négligeant la sécurité routière. L’extension du réseau bitumé apparaît donc comme un facteur favorable à la multiplication des accidents de la route au Burkina Faso.

Background: In the early 2000s, electronic surveillance systems began to be developed to collect and transmit data on infectious diseases in low-income countries (LICs) in real-time using mobile technologies. Such surveillance systems, however, are still very rare in Africa. Among the non-infectious epidemics to be surveilled are road traffic injuries, which constitute major health events and are the fifth leading cause of mortality in Africa. This situation also prevails in Burkina Faso, whose capital city, Ouagadougou, is much afflicted by this burden. There is no surveillance system, but there have been occasional surveys, and media reports of fatal crashes are numerous and increasing in frequency. Objective: The objective of this article is to present the methodology and implementation of, and quality of results produced by, a prototype of a road traffic crash and trauma surveillance system in the city of Ouagadougou. Methods: A surveillance system was deployed in partnership with the National Police over a six-month period, from February to July 2015, across the entire city of Ouagadougou. Data were collected by all seven units of the city’s National Police road crash intervention service. They were equipped with geotracers that geolocalized the crash sites and sent their positions by SMS (short message service) to a surveillance platform developed using the open-source tool Ushahidi. Descriptive statistical analyses and spatial analyses (kernel density) were subsequently performed on the data collected. Results: The process of data collection by police officers functioned well. Researchers were able to validate the data collection on road crashes by comparing the number of entries in the platform against the number of reports completed by the crash intervention teams. In total, 873 crash scenes were recorded over 3 months. The system was accessible on the Internet for open consultation of the map of crash sites. Crash-concentration analyses were produced that identified ‘hot spots’ in the city. Nearly 80% of crashes involved two-wheeled vehicles. Crashes were more numerous at night and during rush hours. They occurred primarily at intersections with traffic lights. With regard to health impacts, half of the injured were under the age of 29 years, and 6 persons were killed. Conclusions: This pilot study demonstrated the feasibility of developing simple surveillance systems, based on mHealth, in LICs.

Introduction: Antipsychotic-induced dystonia is a neurological side-effect and can be very disabling. Treatment is multidisciplinary, including physiotherapy., Objective: The aim was to show the contribution of physiotherapy in the management of people suffering from dystonia secondary to antipsychotics., Method: The Saint John of God Mental Health Centre in Lomé was used as the study setting. This involved a descriptive study about a case of cervical dystonia induced by antipsychotics, from 13 July to 30 August 2020., Results: Our observation concerned a male patient, aged 55 years, suffering from a persistent delirious disorder, on a poorly documented treatment, admitted for cervical dystonia and persistent delirium. A physiotherapy assessment revealed neck pain rated at 5/10, reduced neck muscle strength, and an inability to keep the neck stable at rest. He was started on olanzapine 20mg tablet a day, haloperidol decanoas injectable 50mg/month, and trihexyphenidyl 5mg tablet in the morning. Physiotherapy treatment consisted of 14 sessions using various techniques including passive-active stretching of the neck and head muscles. The evolution was marked by a significant regression of involuntary neck movements and an improvement in the patient's quality of life., Conclusion: Physiotherapy should be more involved in the management of dystonia in psychiatric practice., Competing Interests: Copyright © 2024 by West African Journal of Medicine., (The Authors declare that no competing interest exists.)

Context: Palliative care (PC) in most African countries remains under-assessed. Benin has piloted the implementation of a set of indicators proposed by the WHO to measure PC development., Objectives: To examine the current status of PC in Benin., Methods: A workshop with stakeholders was organized to assess the WHO indicators in the Beninese context. Indicators were rated based on relevance and feasibility, data sources were agreed upon, and a survey was adapted. Data were collected between March and May 2023., Results: There is emerging community involvement in PC through the presence of patients' rights promoters, as well as a political commitment expressed in the National PC strategy, the inclusion of PC services in the list of basic health services, and an assigned national authority -within the Ministry of Health-responsible for PC. Although no PC-oriented research has been documented, the celebration of the National PC Conference represents the first step to ground PC delivery in evidence. The reported annual consumption of opioids is 0.18 (ME) milligrams per capita, 34% of healthcare establishments have essential medicines for pain and PC, and 16.5% of patients with palliative needs have access to oral morphine. To date, no medical or paramedical schools offer PC training, and there is no official specialization in palliative medicine for doctors. PC is provided by 11 specialist teams (0.08/100,000 inhabitants), none of which provides pediatric care., Conclusion: Despite growing political, professional, and community commitments to palliative care, there are challenges in education, research, essential medicines, and access to PC services., (© 2024. The Author(s).)

The cysticercosis is a major zoonotic disease in many developing countries. This study was carried out to determine the prevalence of porcine cysticercosis and to identify potential risk factors associated and their seroprevalence as well in Benin. The tongue palpation was performed on 4150 pigs from the pig farmers were randomly selected to diagnose cysticercosis and to assess the risk factors associated. In slaughterhouses, 792 pigs were inspected. Serum samples from 460 pigs were tested of the presence of Taenia solium cysticercosis using the HP10 antigen-ELISA (Ag-ELISA). A logistic regression model with a 95% confidence interval was used to analyse the main risk factors associated. The tongue palpation revealed a prevalence of 4.79% at the level of slaughterhouses versus 7.82% in the post-mortem inspection. The Ag-ELISA revealed that more than 40% of the pigs were positive. The risk factors identified were the origin area of pigs, the history of cysticercosis in the farms, the presence or absence of a latrine, the pig-farming systems, the age class of pigs and the source of watering. In addition, 34.48% individuals was tested for taenia versus 13.79% for cysticercosis in the hospitals surveyed. Our results showed the major revelation of porcine cysticercosis and its very high level of risk for a public health in all departments of Benin. Therefore, this study suggests the need to continue epidemiological and sociological surveys with a "One Health" approach in order to design and implement effective control measures in this country of high consumption of pigs., (© 2023. The Author(s), under exclusive licence to Springer Nature B.V.)

Background: Children hospitalised with severe acute malnutrition (SAM) are frequently complicated (>50%) by diarrhoea ( ≥3 watery stools/day) which is accompanied by poor outcomes. Rehydration guidelines for SAM are exceptionally conservative and controversial, based upon expert opinion. The guidelines only permit use of intravenous fluids for cases with advanced shock and exclusive use of low sodium intravenous and oral rehydration solutions (ORS) for fear of fluid and/or sodium overload. Children managed in accordance to these guidelines have a very high mortality. The proposed GASTROSAM trial will reappraise current recommendations with mortality as the primary outcome. We hypothesize that liberal rehydration strategies for both intravenous and oral rehydration in SAM children with diarrhoea may reduce adverse outcomes., Methods: An open Phase II trial, with a partial factorial design, enrolling children in Uganda, Kenya, Nigeria and Niger aged 6 months to 12 years with SAM hospitalised with gastroenteritis (>3 loose stools/day) and signs of moderate and severe dehydration. In Stratum A (severe dehydration) children will be randomised (1:1:2) to WHO plan C (100mls/kg Ringers Lactate (RL) with intravenous rehydration (IV) given over 3-6 hours according to age including boluses for shock), slow rehydration (100 mls/kg RL over 8 hours (no boluses)) or WHO SAM rehydration regime (ORS only (boluses for shock (standard of care)). Stratum B incorporates all children with moderate dehydration and severe dehydration post-intravenous rehydration and compares (1:1 ratio) standard WHO ORS given for non-SAM (experimental) versus WHO SAM-recommended low-sodium ReSoMal. The primary outcome for intravenous rehydration is mortality to 96 hours and for oral rehydration a change in sodium levels at 24 hours post-randomisation. Secondary outcomes include measures assessing safety (evidence of pulmonary oedema or heart failure); change in sodium from post-iv levels for those in Stratum A; perturbations of electrolyte abnormalities (severe hyponatraemia <125 mmols/L or hypokalaemia., Discussion: If the trial shows that rehydration strategies for non-malnourished children are safe and improve mortality in SAM this could prompt revisions to the current treatment recommendations or may prompt future Phase III trials., Competing Interests: No competing interests were disclosed., (Copyright: © 2024 Olupot-Olupot P et al.)

Background: Cervical spondyloptosis is a serious condition scarcely encountered by spine surgeons. Few cases have been reported in the literature. There are no general guidelines for their management, especially in delayed cases. The authors describe their surgical technique for the management of cervical spondyloptosis 45 days after the trauma., Observations: A 28-year-old patient was admitted 45 days after head and cervical trauma leading to quadriplegia with muscular strength at the C5 level. Cervical computed tomography scanning and magnetic resonance imaging revealed C6-7 spondyloptosis with complete slippage of the C6 vertebral body in front of C7. Posterior and anterior cervical spine approaches during the same surgery allowed decompression and stabilization, leading to a dramatic improvement in the neurological deficit. The patient was able to walk 18 months later with near normal balance., Lessons: Traumatic cervical spondyloptosis requires early management to increase the possibility of decompression through anatomical realignment and stabilization. In delayed cases, a combined anterior and posterior cervical spine approach according to our technique allows decompression and stabilization with a good postoperative outcome possible.

Background: Many SARS-CoV-2 seroprevalence surveys since the end of 2020 have disqualified the first misconception that Africa had been spared by the pandemic. Through the analysis of three SARS-CoV-2 seroprevalence surveys carried out in Benin as part of the ARIACOV project, we argue that the integration of epidemiological serosurveillance of the SARS-CoV-2 infection in the national surveillance packages would be of great use to refine the understanding of the COVID-19 pandemic in Africa., Methods: We carried out three repeated cross-sectional surveys in Benin: two in Cotonou, the economic capital in March and May 2021, and one in Natitingou, a semi-rural city in the north of the country in August 2021. Total and weighted-by-age-group seroprevalences were estimated and the risk factors for SARS-CoV-2 infection were assessed by multivariate logistic regression., Results: In Cotonou, a slight increase in overall age-standardised SARS-CoV-2 seroprevalence from 29.77% (95% CI: 23.12%-37.41%) at the first survey to 34.86% (95% CI: 31.57%-38.30%) at the second survey was observed. In Natitingou, the globally adjusted seroprevalence was 33.34% (95% CI: 27.75%-39.44%). A trend of high risk for SARS-CoV 2 seropositivity was observed in adults over 40 versus the young (less than 18 years old) during the first survey in Cotonou but no longer in the second survey., Conclusions: Our results show that, however, rapid organisation of preventive measures aimed at breaking the chains of transmission, they were ultimately unable to prevent a wide spread of the virus in the population. Routine serological surveillance on strategic sentinel sites and/or populations could constitute a cost-effective compromise to better anticipate the onset of new waves and define public health strategies., (© 2023 John Wiley & Sons Ltd.)

Background: Having a maximum number of people vaccinated was the objective to control the COVID-19 pandemic. We report in this manuscript the factors associated with the willingness to be vaccinated against COVID-19 during the pandemic period., Methods: From April to May 2022, a community-based cross-sectional survey was performed. Participants were randomly selected from four districts in Benin (taking into account the COVID-19 prevalence). Mixed-effect logistic regression models were used to identify the variables associated with COVID-19 vaccine acceptance., Results: A total of 2069 participants were included. The proportion of vaccine acceptance was 43.3%. A total of 24.2% were vaccinated and showed proof of vaccination. The population's request for vaccination was higher after the third epidemic wave. The district of residence, the education level, a fear of being infected, the channel of information, poor medical conditions, a good knowledge of the transmission mode and symptoms, and good behaviors were significantly associated with vaccine acceptance., Conclusion: The overall acceptance of the COVID-19 vaccine in the Beninese population was relatively high. However, vaccine campaigns in areas with a low acceptance as well as the disclosure of information, particularly on our knowledge of the disease and the safety, side effects, and effectiveness of the COVID-19 vaccines, should be strengthened with adapted and consistent messages.

Objectives: To study pulmonary embolism during COVID-19 pneumonia., Patients and Methods: This was a one-year retrospective and descriptive study of all patients from three imaging sites with SARS-CoV2 infection., Results: Two hundred and thirty-nine patients were included. The prevalence of pulmonary embolism was 18.4%. The average age was 55 years old. The sex ratio was 1.65. Dyspnea (58.6%), cough (56.1%), and chest pain (40.2%) were the most common reasons for consultation. In 151 patients (63.2%), chest computed tomography (CT) angiography was performed without checking level of D-dimer. The level of D-dimers was elevated in 47.8%. Grade 5 of CO-RADS accounted for 62.3%. In 70.5% of cases, the pulmonary embolism was bilateral with subsegmental involvement in 47.7%.Condensation in 'ground glass' with 'crazy paving' were the predominant typical parenchymal lesions with a frequency of 93.7% and 59.4%. In univariate analysis, D-dimers were significantly associated with the occurrence of pulmonary embolism (p < 0.001). Male sex was associated with a non-significantly higher Risk of having a pulmonary embolism (1.18 95% CI: 0.61-2.31, p = 0.622). The critical level increased the risk of pulmonary embolism in a non-significant way. Only the high level of D-dimers was and this, in a significant way., Conclusion: Pulmonary embolism was increased in the context of SARS-CoV2. The chest CT-angiography associated with the dosage of D-dimers constitutes a good diagnostic arsenal., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2023 The Author(s).)

The geographic and evolutionary origins of the SARS-CoV-2 Omicron variant (BA.1), which was first detected mid-November 2021 in Southern Africa, remain unknown. We tested 13,097 COVID-19 patients sampled between mid-2021 to early 2022 from 22 African countries for BA.1 by real-time RT-PCR. By November-December 2021, BA.1 had replaced the Delta variant in all African sub-regions following a South-North gradient, with a peak Rt of 4.1. Polymerase chain reaction and near-full genome sequencing data revealed genetically diverse Omicron ancestors already existed across Africa by August 2021. Mutations, altering viral tropism, replication and immune escape, gradually accumulated in the spike gene. Omicron ancestors were therefore present in several African countries months before Omicron dominated transmission. These data also indicate that travel bans are ineffective in the face of undetected and widespread infection.

The COVID-19 pandemic has significantly disrupted TB services, particularly in low resource settings. In Burkina Faso, a cross-sectional ‘before and after’ study was conducted to assess the impact of COVID-19 on access to TB services. Data was collected in two phases (Phase 1: December 2017−March 2018, and 2: October−December 2020) to estimate and compare various patient and system delays among TB patients before and during COVID-19 and explore changes in treatment seeking behaviors and practices. 331 TB patients were recruited across the two phases. A significant increase in median time between first symptom and contact with TB service (45 days vs. 26 days; p < 0.01) and decrease in median time between first contact and diagnosis, and treatment initiation, respectively, during COVID-19 compared to before. Fewer patients reported using public health centers and more patients reporting using private facilities as the point of first contact following TB symptom onset during the COVID-19 period compared to before. These findings suggest that COVID-19 has created barriers to TB service access and health seeking among symptomatic individuals, yet also led to some efficiencies in TB diagnostic and treatment services. Our findings can be help target efforts along specific points of the TB patient pathway to minimize the overall disruption of COVID-19 and future public health emergencies on TB control in Burkina Faso.

Determination of the self-reported walking capacity by interview or standardized questionnaire is important. However, the existing questionnaires require the patient to be able to read and write in a specific language. We recently proposed the WELSH (Walking Estimated Limitation Stated by History) tool to be administrable to illiterate people. The main objective was to assess the applicability of WELSH tool in the community and in a large group. We performed a prospective study in the city of Bobo-Dioulasso in Burkina Faso during June 2020. We recruited 630 interviewers among medical students. They were trained to administer the WELSH, and to conduct a 6-minute walk test. We performed a Pearson's "r" correlation between the WELSH and maximal walking distance (MWD). Of the 1723 participants available for the analysis, 757 (43.9%: 41.6-46.3) never went to school or attended only elementary school. The percentage of questionnaires with participant filling-in errors corrected by the investigator decreased with the decrease in educational level (p<0.001). The average WELSH score was 53 ± 22 and the average MWD was 383 ±142 meters. The Spearman correlation coefficient between the WELSH score and the MWD was r = 0.567 (p<0.001). Correlations ranged from 0.291 to 0.576 in males and females, (all p values < 0.05) and in different levels of education, with the highest coefficients found in illiterate people. The WELSH is feasible on the community by a wide variety of interviewers. It correlates with the MWD estimated by the 6-minutes' walk test even for people with little or no schooling., Competing Interests: The authors have declared that no competing interests exist.

Objective&#160;: Faced with the uncertainty about the acceptability of COVID-19 vaccination, we conducted this study to better guide communication strategies for health worker adherence to vaccination.Methods&#160;: We conducted a cross-sectional study for analytical purposes, from 15 to 26 February 2021 among health workers in health facilities in the Gb&#234;k&#234; health region.Results&#160;: Health workers were predominantly female (53.5&#160;%) and the 30-39 age group was the most represented (52&#160;%). Television was the main source of information (74.4&#160;%). The respondents knew that they were at risk of contracting COVID-19 (82.5&#160;%) and that people with co-morbidities were the most victim of severe forms (70.4&#160;%). The majority of respondents systematically wear a mask in hospital (91%). They said that 51.1&#160;% of them would get vaccinated. The majority of respondents would systematically wear a mask in hospital (91&#160;%). Multivariate analysis shows that vaccine acceptability was statistically associated with fear of dying from the disease (p=0.046) and case management (p=0.026).Conclusion&#160;: In order to achieve better adherence to COVID-19 vaccination, it would be necessary to strengthen the capacity of these agents.

Severe acute respiratory syndrome coronavirus 2 Delta variant epidemiology in Africa is unknown. We found Delta variant was introduced in Benin during April-May 2021 and became predominant within 2 months, after which a steep increase in reported coronavirus disease incidence occurred. Benin might require increased nonpharmaceutical interventions and vaccination coverage.

Intense transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Africa might promote emergence of variants. We describe 10 SARS-CoV-2 lineages in Benin during early 2021 that harbored mutations associated with variants of concern. Benin-derived SARS-CoV-2 strains were more efficiently neutralized by antibodies derived from vaccinees than patients, warranting accelerated vaccination in Africa.

Background: Malaria transmission is highly seasonal in Niger. Despite the introduction of seasonal malaria chemoprevention (SMC) in the Magaria District, malaria incidence remains high, and the epidemiology of malaria in the community is not well-understood., Methods: Four cross-sectional, household-based malaria prevalence surveys were performed in the Magaria District of Niger between October 2016 and February 2018. Two occurred during the peak malaria season and two during the low malaria season. Individuals in each of three age strata (3-59 months, 5-9 years, and 10 years and above) were sampled in randomly-selected households. Capillary blood was collected by fingerprick, thick and thin blood films were examined. Microscopy was performed at Epicentre, Maradi, Niger, with external quality control. The target sample size was 396 households during the high-season surveys and 266 households during the low-season surveys., Results: Prevalence of parasitaemia was highest in children aged 5-9 years during all four surveys, ranging between 53.6% (95%CI 48.8-63.6) in February 2018 and 73.2% (66.2-79.2) in September 2017. Prevalence of parasitaemia among children aged 3-59 months ranged between 39.6% (33.2-46.4) in February 2018 and 51.9% (45.1-58.6) in October 2016. Parasite density was highest in children aged 3-59 months during all four surveys, and was higher in high season surveys than in low season surveys among all participants. The prevalence of gametocytaemia in children aged 3-59 months ranged between 9.9% (6.5-14.8) in February 2018 and 19.3% (14.6-25.2) in October 2016. The prevalence of gametocytaemia in children aged 5-9 years ranged between 6.3% (3.5-11.1) in February 2018 and 18.5% (12.7-26.1) in October 2016., Conclusions: Asymptomatic malaria infection is highly prevalent in this area, even during the season with low incidence of clinical malaria. The high prevalence of parasitaemia in children aged 5-9 years warrants considering their inclusion in SMC programmes in this context., (© 2021. The Author(s).)