Encouraging impact following 2.5 years of reinforced malaria control interventions in a hyperendemic region of the Republic of Guinea

Background: Malaria is one of the principal causes of morbidity and mortality in the Republic of Guinea, particularly in the highly endemic regions. To assist in malaria control efforts, a multi-component malaria control intervention was implemented in the hyperendemic region of Gueckedou Prefecture. The coverage of the intervention and its impact on malaria parasite prevalence were assessed. Methods: Five cross-sectional surveys using cluster-based sampling and stratified by area were conducted from 2011 to 2013 in three sous-prefectures of Gueckedou Prefecture that received the intervention: Gueckedou City, Tekoulo and Guendembou in addition to one comparison sous-prefecture that did not receive the intervention, Koundou. Surveys were repeated every 6 months, corresponding with the dry and rainy seasons. Rapid diagnostic tests (RDT) were used to diagnose malaria infection. In each selected household, bed net use and ownership were assessed. Results: A total of 35,123 individuals participated in the surveys. Malaria parasite prevalence declined in all intervention sous-prefectures from 2011 to 2013 (56.4-45.9 % in Gueckedou City, 64.9-54.1 % in Tekoulo and 69.4-56.9 % in Guendembou) while increasing in the comparison sous-prefecture (64.5-69 %). It was consistently higher in children 5-14 years of age followed by those 1-59 months and >= 15 years. Indicators of intervention coverage, the proportion of households reporting ownership of at least one bed net and the proportion of survey participants with fever who received treatment from a health facility or community health worker also increased significantly in the intervention areas. Conclusions: Implementation of the multi-component malaria control intervention significantly reduced the prevalence of malaria in the sous-prefectures of intervention while also increasing the coverage of bed nets. However, malaria prevalence remains unacceptably high and disproportionately affects children <15 years of age. In such situations additional vector control interventions and age specific interventions should be considered.