Burden of malaria in young adults in Niger: A prospective study in a military setting

In Niger, malaria remains a major public health issue and cause of economic loss, but its impact on young adults remains poorly documented. Although this population is central to the country's development, it is rarely studied. Our study aims to fill this gap by assessing the burden of malaria in three cohorts of military recruits monitored in different training centers in Niger, a population representative of urban youth. A prospective cohort study was conducted from September to December 2023 in three military health centers. Participants (aged 17-55) had free access to care. All consultations were recorded; any episode of fever resulted in a rapid test and a brief interview. Treatments and hospitalizations were also recorded. A total of 2840 recruits were monitored during two 17-day periods (median age: 27 years; 91.5 % male). The 3193 consultations recorded showed a predominance of respiratory infections in Zinder and digestive disorders in Agadez. Among the 353 confirmed cases of malaria (prevalence 11 %), Niamey had the highest attack rate. Among the patients, 74.5 % were anemic, 44 % were hospitalized, and 55.8 % were temporarily unfit for duty. Grade had a clear influence on preventive knowledge, despite 82 % of respondents reporting that they used mosquito nets. The study estimates that nearly 2000 workdays are lost annually by these young adults, which could be represents 12 millions of days for the whole country, highlighting the need for an integrated and equitable control strategy.