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  • Establishing the extent of malaria transmission and challenges facing pre-elimination in the Republic of Djibouti.

Establishing the extent of malaria transmission and challenges facing pre-elimination in the Republic of Djibouti.

BMC infectious diseases (2011-05-17)
Abdisalan M Noor, Maoulid B Mohamed, Cleopatra K Mugyenyi, Mouna A Osman, Hawa H Guessod, Caroline W Kabaria, Ifrah A Ahmed, Mary Nyonda, Jackie Cook, Christopher J Drakeley, Margaret J Mackinnon, Robert W Snow
ABSTRACT

Countries aiming for malaria elimination require a detailed understanding of the current intensity of malaria transmission within their national borders. National household sample surveys are now being used to define infection prevalence but these are less efficient in areas of exceptionally low endemicity. Here we present the results of a national malaria indicator survey in the Republic of Djibouti, the first in sub-Saharan Africa to combine parasitological and serological markers of malaria, to evaluate the extent of transmission in the country and explore the potential for elimination. A national cross-sectional household survey was undertaken from December 2008 to January 2009. A finger prick blood sample was taken from randomly selected participants of all ages to examine for parasitaemia using rapid diagnostic tests (RDTs) and confirmed using Polymerase Chain Reaction (PCR). Blood spots were also collected on filter paper and subsequently used to evaluate the presence of serological markers (combined AMA-1 and MSP-119) of Plasmodium falciparum exposure. Multivariate regression analysis was used to determine the risk factors for P. falciparum infection and/or exposure. The Getis-Ord G-statistic was used to assess spatial heterogeneity of combined infections and serological markers. A total of 7151 individuals were tested using RDTs of which only 42 (0.5%) were positive for P. falciparum infections and confirmed by PCR. Filter paper blood spots were collected for 5605 individuals. Of these 4769 showed concordant optical density results and were retained in subsequent analysis. Overall P. falciparum sero-prevalence was 9.9% (517/4769) for all ages; 6.9% (46/649) in children under the age of five years; and 14.2% (76/510) in the oldest age group (≥50 years). The combined infection and/or antibody prevalence was 10.5% (550/4769) and varied from 8.1% to 14.1% but overall regional differences were not statistically significant (χ2=33.98, p=0.3144). Increasing age (p<0.001) and decreasing household wealth status (p<0.001) were significantly associated with increasing combined P. falciparum infection and/or antibody prevalence. Significant P. falciparum hot spots were observed in Dikhil region. Malaria transmission in the Republic of Djibouti is very low across all regions with evidence of micro-epidemiological heterogeneity and limited recent transmission. It would seem that the Republic of Djibouti has a biologically feasible set of pre-conditions for elimination, however, the operational feasibility and the potential risks to elimination posed by P. vivax and human population movement across the sub-region remain to be properly established.

MATERIALS
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Corning® 96 Well Poly-D-Lysine Treated Microplate, flat bottom clear, clear polystyrene, bag of 20, sterile, lid
Corning® 96 Well Poly-D-Lysine Treated Microplate, flat bottom clear, black polystyrene, bag of 20, sterile, lid
Corning® 96 Well Clear Polystyrene Microplate, round bottom clear, polystyrene, pkg of Individually wrapped, sterile, lid: no
Corning® 96 Well Clear Polystyrene Microplate, round bottom clear, polystyrene, bag of 25, non-sterile, lid: no
Corning® 96 Well Clear Polystyrene Microplate, round bottom clear, polystyrene, bag of 25, sterile, lid: no
Corning® 96 Well Clear Polystyrene Microplate, round bottom clear, Tissue Culture (TC)-treated surface, ampule of 25, sterile, lid: no
Corning® 96 Well Clear Polystyrene Microplate, flat bottom clear, Tissue Culture (TC)-treated surface, bag of 20, sterile, lid
Corning® 96 well NBS Microplate, flat bottom, white polystyrene, bag of 5 ×, non-sterile, lid: no
Corning® 96 Well Clear Polystyrene Microplate, V-bottom clear, polystyrene, pkg of Individually wrapped, sterile, lid: no
Corning® 96 well NBS Microplate, flat bottom, black polystyrene, bag of 5 ×, non-sterile, lid: no
Corning® 96 Well Clear Polystyrene Microplate, round bottom clear, Tissue Culture (TC)-treated surface, bag of 20, sterile, lid
Corning® 96 Well Clear Polystyrene Microplate, flat bottom clear, polystyrene, bag of 20, sterile, lid
Corning® 96 Well Clear Polystyrene Microplate, V-bottom clear, polystyrene, bag of 25, non-sterile, lid: no
Corning® 96 Well Clear Polystyrene Microplate, V-bottom clear, polystyrene, bag of 25, non-sterile, lid: no
Sigma-Aldrich
o-Phenylenediamine dihydrochloride, peroxidase substrate
Corning® 96 Well Clear PVC Assay Microplate, round bottom clear, PVC, bag of 25 ×, non-sterile, lid: no
Sigma-Aldrich
Corning® 96 well clear polypropylene corner notch microplate, round bottom clear, polypropylene, individually wrapped, sterile, lid