Stratification at the Health District Level for Targeting Malaria Control Interventions in Mali

Abstract

Introduction: Malaria has been the main cause of morbidity and mortality in Mali, with an increase from 2017 to 2020 (2,884,837 confirmed cases and 1,454 deaths). On the recommendation of the World Health Organization (WHO) and for efficient use of resources, Mali has begun a process of malaria stratification. Method: Malaria, entomological and environmental data were collected through the local health information system, the Demographic and Health Survey 2018, research institutions and MALI-METEO services. The WHO stratification based on malaria incidence was used to present a stratified malaria risk map. Environmental factors associated with malaria were identified using a general additive non-linear regression model. The classification and regression tree method was used to improve the stratification. Interventions were proposed according to the incidence stratification and the different environmental, entomological, access to care maps. Results: From 2017 to 2019, the median incidence across the 75 health districts was 129. cases per 1,000 person-year (IQR=86.48). Stratification resulted in 12 health districts of very low, 19 low, 20 moderates and 24 in high transmission areas. Considering the environmental risk associated to malaria incidence, 6 environmental classes were selected. Four different strategies were proposed, from improving 2 surveillance and response to epidemic in the very low and low zones, to access to care improvement in the moderate and high zone. Conclusion: This stratification in Mali will allow targeting malaria control strategies.

Population impact of malaria control interventions in the health district of Kati, Mali

“…The Kati health district is located in a Sudano-Sahelian zone where malaria transmission is seasonal and moderate [21]. Annual rainfall averages 1000 mm and occurs between June and September with an average minimum temperature of 20 0 C and maximum of 35 0 C. It is an area that is crossed by seasonal streams with few permanent streams.…”