Spatio-temporal analysis of the distribution of two primary tools for malaria prevention: long-lasting insecticidal nets and intermittent preventive treatment in Côte d'Ivoire between 2017 and 2019. Analyse spatio-temporelle de la mise à disposition de deux moyens de prévention du paludisme : les moustiquaires imprégnées d'insecticide à longue durée d'action et le traitement préventif intermittent en Côte d'Ivoire entre 2017 et 2019

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Azongnibo, Konan, Rodolphe Mardoché | Assi, Serge Brice | Aimain, Alexis Serge | Niamké, Gnamkémathieu | Kouakou, Aristide Colette, A | Anoh, Kouassi Paul | Fournet, Florence

Edité par CCSD ; Université d'Angers -

International audience. Malaria remains a major public health problem in Africa, which accounts for 94% of cases. Moreover, in West Africa, the prevalence of malaria exposure during pregnancy is the highest. Two primary tools are used for the prevention of malaria: long-lasting insecticidal nets (LLINs) and intermittent preventive treatment (IPT) for pregnant women. Côte d’Ivoire has access to these prevention methods recommended by the WHO. National campaigns for the distribution of LLINs are regularly organized nationwide. Alongside the widespread distribution of LLINs, these primary tools are also administered through the Expanded Program on Immunization (EPI) for children and during antenatal care (ANC) for pregnant women, where IPT is also provided. Despite the crucial importance of these interventions, there remains a significant lack of data regarding the extent of LLINs and IPTs coverage in Côte d'Ivoire. Access to such information is pivotal for enhancing malaria prevention efforts by enabling more targeted and effective interventions.The objective of this study was to analyze the distribution rates of long-lasting insecticidal nets (LLINs) and the third dose of intermittent preventive treatment (IPT3) in the health districts of Côte d'Ivoire from 2017 to 2019. The data utilized were sourced from the national malaria control program (NMCP), encompassing the quantities of LLINs dispensed during ANC for pregnant women and under the EPI for children. Additionally, the numbers of IPT3 administered to pregnant women during ANC for the same period (2017-2019) were included.The distribution rates of MILDA and IPT3 were calculated following the methods used by the Ministry of Health. They were mapped for each health district and for each year of the study (2017, 2018, and 2019) using QGIS 3.28 software. The global spatial autocorrelation index of Moran (Moran's I) was then calculated for each prevention method. When the global Moran's index indicated the presence of clusters, complementary analyses were conducted using Local Indicators of Spatial Association (LISA), which allow for the identification of spatial aggregations of high or low values. This methodology was employed to pinpoint health districts characterized by low distribution rates of LLINs or IPT3. The Moran's index and LISA were calculated using GeoDA 1.20.The distribution rates of LLINs during ANC ranged from 49.3% to 74.2%, and from 49.3% to 69.1% under the EPI. Meanwhile, the distribution rate of IPT3 ranged between 40% and 46.1% during the analysis period. The spatial indices measured for the distribution rate of MILDA in EPI and ANC showed no spatial aggregation for all years of the analysis period (2017-2019).As for the distribution rate of IPT3, aggregations were observed in 2018 and 2019, and the LISA analysis indicates that it is in the eastern part of the country where health districts with the highest distribution rates of IPT3 are concentrated. The western part of the country harbors health districts with the lowest distribution rates of IPT3 in 2018, whereas in 2019, it is the northern part of the country that concentrates health districts with the lowest distribution rates of IPT3.Despite limitations due to the use of data reported by the healthcare system, our study highlights that the distribution rate of MILDA to children under 5 and pregnant women remains below the 80% threshold targeted by the National Malaria Control Program (PNLP) of Côte d'Ivoire since 2017. The distribution rate of IPT3 tends to approach the goals of the PNLP of Côte d'Ivoire, which were set at 60% in 2017 and 80% in 2019. Some socio-cultural barriers may explain this situation and should be explored to improve malaria prevention, which remains inadequate, especially in healthcare areas located in the western part of the country where malaria incidence is very high. . Peu de données sont disponibles pour évaluer la couverture en moustiquaires imprégnées d’insecticide à longue durée d’action (MILDA) et en traitement préventif intermittent (TPI) en Côte d’Ivoire alors que ces informations permettraient d’améliorer la prévention du paludisme.L’objectif de l’étude était d’analyser le taux de distribution de MILDA et de la troisième dose de TPI (TPI3) à l’échelle des districts sanitaires de la Côte d’Ivoire entre 2017 et 2019. Les données utilisées, issues du système de soins, correspondent au nombre de MILDA distribuées lors des consultations prénatales (CPN) et par le programme élargi de vaccination aux enfants, ainsi que le nombre de TPI3 distribué aux femmes enceintes en CPN. Les taux de distribution ont été analysés par les indices de Moran. Les analyses mettent en évidence les zones ouest et nord-ouest comme des zones de concentration de districts sanitaires présentant des taux de distribution de MILDA et de TPI3 faibles.

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