Benin

Malaria Burden

ill child, mother and health worker

Malaria is endemic to Benin, and is the leading cause of mortality among children under five years of age and of morbidity among adults. It accounts for 40% of outpatient consultations and 25% of all hospital admissions.

The  number of cases overall decreased by 4% between 2015 and 2019 (from 423 per 1000 population to 406 per 1000) while early care-seeking rate in case of fever in children under five years of age is 53% (2017). 2  What is more, the number of deaths decreased 5% between 2015 and 2019 (from 0.63 per 1000 population to 0.60), the mortality rate for children under five years of age has dropped from 125 per 1000 in 2006 to 96 per 1000 in 2017.3

The disease places a significant economic strain on Benin’s development. The World Bank estimates that households in Benin spend approximately one-quarter of their annual income on the prevention and treatment of malaria.

Severe malaria case management 

In 2019, Benin adopted injectable artesunate as the new first line treatment for severe malaria. With this change, procurement and distribution of parental quinine, previously the first-line treatment for severe malaria, was stopped.1

Artesunate rectal capsules (ARC) are the recommended intervention for the pre-referral of children with severe malaria from primary health facilities to the hospitals where severe malaria is treated.1

The National Malaria Control Program (NMCP) objectives for IPTp are that pregnant women should receive at least three doses of sulfadoxine pyrimethamine (SP) under direct supervision of a health providers for protection against malaria. However, uptake of IPTp 3 rate is still low at 13.7%.2

Benin adopted seasonal malaria chemoprevention (SMC) in 2018. Four eligible health zones (Sahelian zones neighboring Burkina Faso and Niger) were identified for implementation. Approximately 100,000 children from 3 to 59 months are targeted, and results from the first 2019 SMC implementation were promising in terms of decreasing malaria morbidity and mortality in the targeted areas.1 

Malaria control interventions

Large-scale implementation of artemisinin-based combination therapies (ACTs) and intermittent preventive treatment for pregnant women (IPTp) began in Benin in 2007 and has progressed rapidly. Rapid diagnostic tests, ACTs, and IPTp are being used in public health facilities nationwide and are being introduced into registered private clinics.1

More than 6 million long-lasting insecticide-treated nets have been distributed through mass and continuous distribution channels. Benin has shown significant improvements in net ownership. Ownership of insecticide-treated mosquito nets (ITNs) has on the other hand improved from 25% in 2006 to 92% in 2017.1
 

Challenges in addressing uncomplicated and severe malaria1 

  • With the adoption in 2019 of injectable artesunate as the first line treatment for severe malaria, there is a pressing need to fill stocks at all levels of the distribution system.  
  • Although 53% of patients or their caregivers in case of children eventually seek treatment, only 28% do so promptly.  
  • Limited catchment area of community health agents. This shortage makes it difficult for caregivers in remote communities to seek prompt, proper care. 
  • Health workers who are non-skilled, and not trained in malaria guidelines are the most likely to receive patients in health facilities. 
  • More than 50% of pregnant women attend at least 4 antenatal care visits (ANC 4).  However, only 14% of women reported receiving at least 3 doses of IPTp. 
  • Insecticide resistance, in particular resistance to pyrethroids, a crucial chemical on ITNs, continues to be a major threat to vector control. 

Malaria-related admissions and deaths

Malaria-related admissions and deaths

Distribution of malaria cases within Benin

Distribution of malaria cases within Benin

Severe malaria policy and practice

National treatment guidelines

Recommendation

Treatment

Strong

IV artesunate

Alternative

IM Arthemether

Pre-referral

Rectal Artesunate

Pregnancy

Recommendation

Protection

IPTp

Sulfadoxine/pyrimethamine

Sources of malaria financing: Benin

Benin: sourcing of malaria financing