AUTHOR=Coulibaly Drissa , Kone Abdoulaye K. , Kane Bourama , Guindo Bouréima , Tangara Bourama , Sissoko Mody , Maiga Fayçal , Traore Karim , Diawara Aichatou , Traore Amidou , Thera Ali , Sissoko Mahamadou S. , Doumbo Ogobara K. , Travassos Mark A. , Thera Mahamadou A. 

TITLE=Shifts in the clinical epidemiology of severe malaria after scaling up control strategies in Mali

JOURNAL=Frontiers in Neurology

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.988960

DOI=10.3389/fneur.2022.988960

ISSN=1664-2295

ABSTRACT=A decrease in malaria incidence following implementation of control strategies such as use of artemisinin-based combination therapies, insecticide-impregnated nets, intermittent preventive treatment during pregnancy and seasonal malaria chemoprevention (SMC) has been observed in many parts of Africa. We hypothesized that changes in malaria incidence is accompanied by a change in the predominant clinical phenotypes of severe malaria.

To test our hypothesis, we used data from a severe malaria case-control study that lasted from 2014-2019 to describe clinical phenotypes of severe forms experienced by participants enrolled in Bandiagara, Bamako, and Sikasso, in Mali. We also analyzed data from hospital records of inpatient children at a national referral hospital in Bamako. 

Among 97 cases of severe malaria in the case-control study, there was a predominance of severe malarial anemia (49.1%). The frequency of cerebral malaria was 35.4%, and 16.5% of cases had a mixed clinical phenotype (concurrent cerebral malaria and severe anemia). National referral hospital record data in 2013-15 showed 24.3% of cases had severe malarial anemia compared to 51.7% with cerebral malaria. In the years after SMC scale-up, severe malarial anemia cases increased to 30.1%, (P=0.019), whereas cerebral malaria cases decreased to 45.5% (P=0.025). In addition, the predominant age group for each severe malaria phenotype was the 0–1-year-olds.

The decrease in malaria incidence noted with the implementation of control strategies may be associated with a change in the clinical expression patterns of severe malaria, including a potential shift in severe malaria burden to age groups not receiving seasonal malaria chemoprevention