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Environmental, entomological, socioeconomic and behavioural risk factors for malaria attacks in Amerindian children of Camopi, French Guiana

Aurélia Stefani1, Matthieu Hanf12, Mathieu Nacher12, Romain Girod3 and Bernard Carme124*

Author Affiliations

1 EPaT Team (EA3593), UFR de Médecine - Université des Antilles et de la Guyane, Cayenne, French Guiana

2 Centre d'Investigation Clinique - Epidémiologie Clinique Antilles Guyane (CIE 802 INSERM), Cayenne General Hospital, French Guiana

3 Unité d'Entomologie Médicale, Institut Pasteur de la Guyane, Cayenne, French Guiana

4 Laboratoire Hospitalo-Universitaire de Parasitologie Mycologie, Cayenne General Hospital, French Guiana

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Malaria Journal 2011, 10:246  doi:10.1186/1475-2875-10-246

Published: 23 August 2011

Abstract

Background

Malaria is a major health issue in French Guiana. Amerindian communities remain the most affected. A previous study in Camopi highlighted the predominant role of environmental factors in the occurrence of malaria. However, all parameters involved in the transmission were not clearly identified. A new survey was conducted in order to clarify the risk factors for the presence of malaria cases in Camopi.

Methods

An open cohort of children under seven years of age was set up on the basis of biologically confirmed malaria cases for the period 2001-2009. Epidemiological and observational environmental data were collected using two structured questionnaires. Data were analysed with a multiple failures multivariate Cox model. The influence of climate and the river level on malaria incidence was evaluated by time-series analysis. Relationships between Anopheles darlingi human biting rates and malaria incidence rates were estimated using Spearman's rank correlation.

Results

The global annual incidence over the nine-year period was 238 per 1,000 for Plasmodium falciparum, 514 per 1,000 for Plasmodium visa and 21 per 1,000 for mixed infections. The multivariate survival analysis associated higher malaria incidence with living on the Camopi riverside vs. the Oyapock riverside, far from the centre of the Camopi hamlet, in a home with numerous occupants and going to sleep late. On the contrary, living in a house cleared of all vegetation within 50 m and at high distance of the forest were associated with a lower risk. Meteorological and hydrological characteristics appeared to be correlated with malaria incidence with different lags. Anopheles darlingi human biting rate was also positively correlated to incident malaria in children one month later.

Conclusions

Malaria incidence in children remains high in young children despite the appearance of immunity in children around three years of age. The closeness environment but also the meteorological parameters play an important role in malaria transmission among children under seven years of age in Camopi.