Caractéristiques épidémiologiques du paludisme dans la commune de Corail, Grande Anse, Haïti

Abstract

Malaria is considered to be a major problem of public health in Haiti. However the impact of Plasmodium falciparum on health is poorly known in this country. The objective of this study is to verify the incidence of malaria as the cause of hospital consultation and to evaluate the rate of P. falciparum gametocytes carriage among the population living in a municipality within the Department of Grand'Anse where the prevalence of malaria is considered one of the strongest in Haiti. Analysis of hospital statistics of Corail (Grand'Anse) showed that only 17.4% of consultations of patients presenting with fever are due to microscopically confirmed malaria. The fraction of the population most affected is that of adults aged 15-39 years (55% of cases). Children under five represent only 11% of the cases. A community survey showed the rarity of the carriage of gametocytes in asymptomatic persons (0.9%). In Haiti, the epidemiological characteristics of malaria must have specified and documented field studies in order to adapt a strategy for fighting against this parasitic disease with greater efficiency.

High prevalence of asymptomatic malaria infections: a cross-sectional study in rural areas in six departments in Haiti

“…Comparatively high malaria prevalence has been reported previously in the Grande Anse, Nord and Sud-Est Departments [ 7 , 18 ], however, none of the reported data accurately captured the sub-microscopic levels of infection. There is no national policy on active cross-sectional surveillance to monitor number of asymptomatic or sub-microscopic carriers of parasite in the country.…”

“…Haiti would have to maintain zero locally acquired cases for at least 3 years prior to becoming certified malaria-free country by WHO [ 34 ]. The current status seems ambiguous, since official records indicate a reduced overall number of clinical cases from ~80,000 in 2010 to ~17,000 in 2014 [ 6 ] and hyperendemic foci of malaria remain despite current control efforts [ 7 , 18 ]. All official published data acquired from hospitals and dispensaries across Haiti represent only data from febrile cases, yet in an area experiencing high transmission only 17 % of all acute febrile illnesses were attributed to malaria [ 7 ].…”

“…Although microscopy remains globally the gold standard for diagnosing malaria [ 3 , 4 ], the accuracy of slide reading and their quality control remains questionable in Haiti [ 5 ]. Malaria remains high on the differential list of non-respiratory acute febrile illnesses in Haiti, despite the fact that in recent studies only about 3–17 % of these cases are confirmed as malaria by either microscopy or RDT [ 6 , 7 ]. Official reporting of malaria cases to the LNSP is recognized as under-representing the true burden of malaria [ 2 ].…”

“…Further, the importance of these asymptomatic infections rises when transmission levels are low such as in Haiti, where the overall official prevalence seems to range between 0.1–1 % [ 2 , 17 ]. Despite the low prevalence of febrile cases, multiple studies have pointed out the high prevalence of asymptomatic carriers using only microscopy for diagnosis [ 7 , 18 ]. Additional sub-microscopic infections remain unidentified, and will require implementing new survey tools capable of identifying them.…”

Malaria elimination in Haiti by the year 2020: an achievable goal?

“…Malaria is an important public health concern in Haiti with 17,094 reported cases in 2014 by the Service de Suivi et d’Evaluation of the Programme National de Contrôle de la Malaria (PNCM) (private database); however, it has been estimated that up to 220,000 cases may be present, with an estimated 80 % of the population at risk of acquiring an infection [2–8]. In patients presenting to clinics in Haiti with undifferentiated acute febrile illness, 3 to 47 % were malaria positive [3–12]. The morbidity and economic impact of malaria is enormous, with infections being both a cause and a result of poverty [13].…”