Background: Despite a global decrease in malaria burden worldwide, malaria remains a major public health concern, especially in Benin children, the most vulnerable group. A better understanding of malaria's spatial and agedependent characteristics can help provide durable disease control and elimination. This study aimed to analyze the spatial distribution of Plasmodium falciparum malaria infection and disease among children under five years of age in Benin, West Africa. Methods:A cross-sectional epidemiological and clinical survey was conducted using parasitological examination and rapid diagnostic tests (RDT) in Benin. Interviews were done with 10,367 children from 72 villages across two health districts in Benin. The prevalence of infection and clinical cases was estimated according to age. A Bayesian spatial binomial model was used to estimate the prevalence of malaria infection, and clinical cases were adjusted for environmental and demographic covariates. It was implemented in R using Integrated Nested Laplace Approximations (INLA) and Stochastic Partial Differentiation Equations (SPDE) techniques. Results:The prevalence of P. falciparum infection was moderate in the south (34.6%) of Benin and high in the northern region (77.5%). In the south, the prevalence of P. falciparum infection and clinical malaria cases were similar according to age. In northern Benin children under six months of age were less frequently infected than children aged 6-11, 12-23, 24-60 months, (p < 0.0001) and had the lowest risk of malaria cases compared to the other age groups (6-12), (13-23) and (24-60): OR = 3.66 [2.21-6.05], OR = 3.66 [2.21-6.04], and OR = 2. 83 [1.77-4.54] respectively (p < 0.0001). Spatial model prediction showed more heterogeneity in the south than in the north but a higher risk of malaria infection and clinical cases in the north than in the south. Conclusion:Integrated and periodic risk mapping of Plasmodium falciparum infection and clinical cases will make interventions more evidence-based by showing progress or a lack in malaria control.

Background:In Benin, malaria remains endemic and perennial throughout the year in most areas. During the last decade, a substantial increase was noticed in the procurement of Artemisinin-based combination therapies and malaria RDT. This study aimed to evaluate the quality of uncomplicated malaria cases-management in public and private health facilities.Methods:A cross-sectional survey was carried out in public and private health facilities in the municipality of Abomey-Calavi in southern Benin from August to September 2016. The study focused on two targets: (i) patients with uncomplicated malaria who sought care in a health facility in Abomey-Calavi during the study period; and (ii) the health care providers in public and private health facilities authorized by the Ministry of Health.Results:In 27 health facilities investigated, 15 in the public sector and 12 in the private sector, a total of 313 patients and 93 health care providers were included. Forty-four percent (44%) had no education. Among the patients, 60% were identified in the public health facilities. About 87% of uncomplicated malaria patients were tested in public facilities while 63% were tested in private facilities. In the same way, 54% of patients were treated in accordance with National Malaria Control Program (NMCP) guidelines.Conclusions:The present study showed a poor performance in uncomplicated malaria case-management in private health facilities compared to public health facilities. Strategy to improve access and utilization of malaria case-management supplies needs to be reviewed in both public and private health facilities.

BackgroundArtemisinin-based combination therapy (ACT), used to treat uncomplicated malaria cases, is one of the main strategies of malaria control and elimination. One of the main objectives of the Benin National Malaria Control Program’s (NMCP) strategic plan is to ensure that at least 80% of uncomplicated malaria is treated with ACT within 24 h. Therefore, it was of great interest to measure whether the country case management of fever amongst children under five, adhered to the NMCP’s strategic plan and look into the barriers to the use of ACT.MethodsA cross-sectional survey based on a cluster and multi-stage sampling was conducted in two rural health districts in Benin. We recruited 768 and 594 children under five years were included in the northern and in the southern respectively. Data was collected on the general use of ACT and on the correct use of ACT that adheres to the NMCP’s strategy, as well as the barriers that prevent the proper management of fever amongst children. To assess the certain predictors of ACT usage, logistic regression was used, while taking into account the cluster random effect.ResultsAmong febrile children aged 6 to 59 months, 20.7% in the south and 33.9% in north received ACT. The correct use of ACT, was very low, 5.8% and in southern and 8.6% northern areas. Caregivers who received information on ACT were 3.13 time more likely in the south and 2.98 time more likely in the north to give ACT to their feverish child, PPR = 3.13[1.72–4.15] and PPR = 2.98 [2.72–3.11] respectively. Chloroquine and quinine, other malaria treatments not recommended by NMCP, were still being used in both areas: 12.3 and 3.3% in the south and 11.4 and 3.0% in the north.ConclusionIn Benin, the use and the correct use of ACT for febrile children remains low. The study also showed that having received information about the use of ACT is positively associated with the use of ACT. This point highlights the fact that efforts may not have been sufficiently integrated with social communication, which should be based on the behavioural determinants of populations.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-5077-6) contains supplementary material, which is available to authorized users.