A Decade of Progress Accelerating Malaria Control in Mali: Evidence from the West Africa International Center of Excellence for Malaria Research

Abstract

This article highlights over a decade of signature achievements by the West Africa International Centers for Excellence in Malaria Research (WA-ICEMR) and its partners toward guiding malaria prevention and control strategies. Since 2010, the WA-ICEMR has performed longitudinal studies to monitor and assess malaria control interventions with respect to space-time patterns, vector transmission indicators, and drug resistance markers. These activities were facilitated and supported by the Mali National Malaria Control Program. Research activities included large-scale active and passive surveillance and expanded coverage of universal long-lasting insecticide-treated bed nets and seasonal malaria chemoprevention (SMC). The findings revealed substantial declines in malaria occurrence after the scale-up of control interventions in WA-ICEMR study sites. WA-ICEMR studies showed that SMC using sulfadoxine-pyrimethamine plus amodiaquine was highly effective in preventing malaria among children under 5 years of age. An alternative SMC regimen (dihydroartemisinin plus piperaquine) was shown to be potentially more effective and provided advantages for acceptability and compliance over the standard SMC regimen. Other findings discussed in this article include higher observed multiplicity of infection rates for malaria in historically high-endemic areas, continued antimalarial drug sensitivity to Plasmodium falciparum, high outdoor malaria transmission rates, and increased insecticide resistance over the past decade. The progress achieved by the WA-ICEMR and its partners highlights the critical need for maintaining current malaria control interventions while developing novel strategies to disrupt malaria transmission. Enhanced evaluation of these strategies through research partnerships is particularly needed in the wake of reported artemisinin resistance in Southeast Asia and East Africa.

Figure 1.

Temporal changes in overall prevalence of P. falciparum infection (based on microscopy) at the end of the transmission season (October). (A) Dangassa and (B) Dioro, from 2012 to 2020, and (C) Koulikoro, from 2018 to 2020. Surveys were not performed in 2013 and 2017 at the end of the transmission season in Dangassa and Dioro, and surveys started in 2018 at the Koulikoro site. The error bars indicate the standard deviation for each estimate.

Figure 2.

Temporal changes in age-specific prevalence of P. falciparum infection (based on microscopy) at the end of the transmission season (October). (A) Dangassa and (B) Dioro, from 2012 to 2020, and (C) Koulikoro, from 2018 to 2020. The error bars indicate the standard deviation for each estimate.

Figure 3.

Standard = comparison arm 1 villages, where SP-AQ provided to children aged between 3 months and 5 years only (Standard SMC in Mali). SP-AQ sulfadoxine-pyrimethamine plus amodiaquine, comparison arm 2 villages where SP-AQ provided to children aged between 3 months and 9 years (SMC extended to older children with SP-AQ). DHA-PQ = dihydroartemisinin plus amodiaquine, comparison arm 3 villages, where DHA-PQ provided to children aged between 3 months and 9 years old (SMC extended to older children with DHA-PQ). Panel A shows Plasmodium falciparum malaria incidence rates among children under 5 years old by study arm. Panel B shows Plasmodium falciparum malaria incidence rates by study arm among children 5–9 years old. This figure appears in color at www.ajtmh.org.