[Changes in malaria prevalence and management of fevers from 2000 to 2012 in Casamance, Senegal]

Before 2006 in Senegal, in the absence of clinical diagnosis, all fever cases were considered as malaria and treated with chloroquine. Between 2004-2006, to face the dramatic increase of Plasmodium falciparum resistance to chloroquine, the combination of amodiaquine plus sulfadoxine-pyriméthamine was recommended for treatment. In 2006, rapid diagnostic tests were introduced and the treatment with a combination of artesunate plus amodiaquine (ASAQ) became the national recommendation for malaria treatment in 2007. This coincided with a decrease of the prevalence of malaria cases and change in fever management. Since 1995 in Mlomp in Casamance, thin and thick blood smear examination has systematically been done in patients with fever and clinical signs of malaria, and treatment with ASAQ given as experimental procedure. Between 2000 and 2012, 70,892 outpatients were attending the health center, and 51.2% of them for fever. Among these fever cases, 72.4% were suspected of malaria and 27.6% were identified as bacterial and viral infections. Confirmed malaria cases decreased dramatically from 1365 in 2000 to 53 in 2012. While comparing the 2 periods 2000-2006 and 2007-2012, the number of fever cases decreased by half, the number of fever identified as non malaria doubled and malaria treatment given decreased by 86%. Improvement of fever management in Mlomp has contributed to a better identification of their cause and to a decrease of inappropriate malaria treatments.