Low autochtonous urban malaria in Antananarivo (Madagascar)

Léon Paul Rabarijaona¹ , Frédéric Ariey¹^,5 , Robert Matra² , Sylvie Cot¹ , Andrianavalona Lucie Raharimalala¹ , Louise Henriette Ranaivo³ , Jacques Le Bras² , Vincent Robert¹^,4 and Milijaona Randrianarivelojosia¹

¹Institut Pasteur de Madagascar, BP 1274 Antananarivo-101, Madagascar

²Institut Santé et Développement, Université Pierre et Marie Curie, Université Pierre et Marie Curie Paris VI, 12 rue Cuvier, 75005 PARIS, France

³Service de lutte contre le paludisme, Ministère de la Santé et du Planning Familial, BP 460, Soarano, Analakely, Antananarivo-101, Madagascar

⁴IRD UR77/MNHN USM504, 61 rue Buffon, 75231 Paris cedex 05, France

⁵Institut Pasteur de Phnom Penh, Cambodge

author email corresponding author email

Malaria Journal 2006, 5:27doi:10.1186/1475-2875-5-27


Published:	31 March 2006

Abstract

Background

The study of urban malaria is an area undergoing rapid expansion, after many years of neglect. The problem of over-diagnosis of malaria, especially in low transmission settings including urban areas, is also receiving deserved attention. The primary objective of the present study was to assess the frequency of malaria among febrile outpatients seen in private and public primary care facilities of Antananarivo. The second aim was to determine, among the diagnosed malaria cases, the contribution of autochthonous urban malaria.

Methods

Two cross-sectional surveys in 43 health centres in Antananarivo in February 2003 (rainy season) and in July 2003 (dry season) were conducted. Consenting clinically suspected malaria patients with fever or history of fever in the past 48 hours were included. Malaria rapid diagnostic tests and microscopy were used to diagnose malaria. Basic information was collected from patients to try to identify the origin of the infection: autochthonous or introduced.

Results

In February, among 771 patients, 15 (1.9%) positive cases were detected. Three malaria parasites were implicated: Plasmodium. falciparum (n = 12), Plasmodium vivax (n = 2) and Plasmodium. ovale (n = 1). Only two cases, both P. falciparum, were likely to have been autochthonous (0.26%). In July, among 739 blood smears examined, 11 (1.5%) were positive: P. falciparum (n = 9) and P. vivax (n = 2). Three cases of P. falciparum malaria were considered to be of local origin (0.4%).

Conclusion

This study demonstrates that malaria cases among febrile episodes are low in Antananarivo and autochthonous malaria cases exist but are rare.