Prevalence of Plasmodium falciparum infection in school-aged children in urban and peri-urban schools of Bamako, Mali

Mahamoudou Toure^1,2*Fousseyni Kane^1,2Daouda Sanogo^1,2Soumba Keita^1,2Bourama Keita^1,2Abdoul Zamilou Aro^1,2Moussa Keita^2,3,4Drissa Konate^1,2Sory I Diawara^1,2Alpha S Yaro^1,2,4Aissata Kone⁵Mahamadou Magassa⁵Salim Kante^1,2Cheick Oumar Tangara^1,2Bourema Cisse^1,2Karamoko Tangara^1,2Hamady Coulibaly^1,2Sidibe M'Baye Thiam^1,2Amadou Sekou Traore^1,2JEFFREY G. SHAFFER⁶Nafomon SOGOBA^1,2,4Mahamadou DIAKITE^1,2Seydou Doumbia^1,2

• ¹University Clinical Research Center (UCRC), Université des Sciences, des Techniques et des Technologies de Bamako, Bamako, Mali
• ²International Center for Excellence in Malaria Research - ICEMR Mali, Bamako, Mali
• ³Université des Sciences, des Techniques et des Technologies de Bamako, Bamako, Bamako Capital District, Mali
• ⁴Malaria Research and Training Center - Entomology MRTC-E, Bamako, Mali
• ⁵National Malaria Control Program , NMCP, Bamako, Mali
• ⁶School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, United States

Urban malaria is an increasing public health issue for Africans in cities experiencing rapid demographic growth. School children bear the high burden of malaria which affects their health and education while they are not covered by control strategies such as Seasonal Malaria Chemoprevention. This study aims to evaluate the school-based prevalence of P. falciparum infection to inform targeted malaria control strategies in urban and peri-urban settings of Bamako, Mali.The city of Bamako in Mali was divided into four ecological strata based on the risk for malaria transmission using GIS tools (urban center, high altitude, riverside, and peripheral neighborhoods). Within each stratum, three schools close to the community health center were chosen to randomly select 200 to 230 children aged 6 to 13 years old per school to collect information on malaria risk factors and test for P. falciparum infection using malaria Rapid Diagnostic Tests (mRTD) and microscopy.Overall, the prevalence of P. falciparum infection varied from 0% to 15.5% between study sites.Travel history and fever were not associated with increased risk of infection (p>0.05). The odds of malaria infection increased by 2.4 among children with anemia (OR= 2.38, 95% CI [1.57, 3.61]) and 3.8 among children living in an urban site along the Niger River (OR= 3.37, 95% CI] [2.05, 7.45]).This study shows significant spatial variation of P. falciparum infection within Bamako urban settings. The results suggest that, as in rural villages of Mali, school-aged children should be considered a major malaria parasite reservoir in urban settings of Bamako. Interventions targeting this specific age group could reduce the malaria burden in this area.