Burkina Faso

Malaria facts

Malaria is a major health issue in Burkina Faso. It is endemic throughout the country, with a seasonal upsurge from June through October. This seasonal peak is variable across the three major geographic zones linked with the duration of the rainy season: up to three months in the north, six months in the centre, and nine months in the south of the country.

Overall, Burkina Faso is among the ten countries with the highest number of malaria cases and deaths (3% of the global cases and 4% of global deaths).[1] Malaria is responsible for 43% of health provider consultations and 22% of deaths. 

Mortality rates fell by 17.3% between 2016 and 2019 – from 0.87 to 0.72 per 1000 of the population at risk. Case numbers also fell in the same period, from 402 to 387 per 1000 of the population at risk.[1]

To reduce the burden of malaria in the country, the high burden to high impact (HBHI) approach was introduced in Burkina Faso in November 2019.[1]

Severe malaria in pregnancy and children

Burkina Faso is among the 20 countries where the prevalence of exposure to malaria infection during pregnancy was 30% or more while maternal anaemia was over 40% in 2018.[1] It was estimated that 50% of children under the age of five also had moderate or severe anaemia in 2018.[1]

PMI projections estimate that, in 2021, there will be 28,405 cases of severe malaria in pregnant women, and 289,557 cases of severe malaria in children.[2]

Severe malaria case management

Treatment of severe malaria is performed at the hospital and Centre de santé et de la promotion sociale (CSPS) level. The National Malaria Control Program (NMCP) is currently piloting pre-referral rectal artesunate for children under five years of age by community health workers in three districts in the North and Sahel regions, where malaria mortality is the highest.

The first-line treatment for severe malaria in public health facilities is intravenous artesunate; in its absence, injectable quinine may be used. The NMCP recommends the use of intramuscular artemether in private health facilities capable of providing severe malaria treatment. [2]

Malaria in pregnancy

Burkina Faso has adopted the 2016 WHO antenatal care guidance and encourages early initiation of intermittent preventive treatment for pregnant women (IPTp), beginning at 13 weeks. The primary challenges to implementation of the guidelines remain a relatively late start to antenatal care for the majority of pregnant women. Even though an increasing proportion of women are being seen during the first trimester of pregnancy since 2015, only a third of women are seen during this time, which reduces the potential number of contacts for future IPTp delivery over the course of the pregnancy.

Case management of severe malaria in children under five and pregnant women is funded by the national budget.[2] Emergency kits are also provided to pregnant women and children under five years of age with severe malaria.[2]

82% of pregnant women received two or more doses of intermittent preventative treatment of malaria in pregnancy (IPTp) in 2017–18 (48% in 2014), while 58% received three or more doses of IPTp during their pregnancy in 2017–18 (22% in 2014).[2]

Purchase of rectal and injectable artesunate

PMI plans to procure one million vials of injectable artesunate for 2021 (as in 2020) as well as 6 million artemisinin-based combination therapies (ACTs) for Burkina Faso for 2021, having procured 6 million ACTs for 2020. In 2020, there was a gap of six million ACTs that the Global Fund planned to address with emergency funds. [2]

Healthcare facilities

Since 2008, the country has consistently allocated at least 15% of its annual public budget to healthcare. Several health services are completely free. These include malaria treatment and insecticide-treated bed nets for children under five years of age and pregnant women.[2]

  • Intermediate health care level: comprises 13 health regions with eight regional hospitals that serve as referral centers;
  • Peripheral health level: 70 health districts with 45 district hospitals, 57 medical centers and 1,839 health facilities;
  • Private sector facilities: 133 hospitals, 397 medical and nursing centers, 45 health facilities run by NGOs or faith-based organizations, 140 biomedical laboratories, 246 private pharmacies, and 617 private drug sellers.

Community case management

Training and supervising community health workers (CHWs) in malaria case management is part of the NMCP’s strategy to improve nationwide diagnosis and treatment of malaria. There are two CHWs per village throughout Burkina Faso, and up to four in villages with more than 2,000 inhabitants.

Integrated community case management occurs in villages that are further than 5km from the nearest health facility (12 568 out of 17,668 villages).

Health communication and advocacy

A National 2016-2020 Communication Strategy was finalized in February 2017. The communication strategy’s objectives now include Seasonal Malaria Chemoprevention (SMC), IPTp, and the administration of pre-referral artesunate rectal capsules at the community level.7 Activities to advance this strategy include mass communication campaigns, advocacy with community leaders, interpersonal communication with community health workers (CHWs), and development of new social and behaviour change communication tools.

Commodity availability

In 2019, the central stock levels of malaria commodities have generally been maintained, with some increases in stock availability prior to the higher transmission season.

At the facility- and community health worker-level, stock out rates were low for rapid diagnostic tests (RDTs), sulfadoxine-pyrimethamine (SP), and most artemether-lumefantrine (AL) treatments. Even when there was a high stockout rate of certain AL presentations, stockouts of all ACTsconsistently remain low (below 10 percent), indicating good availability for treatment. The stock out rate for SP + amodiaquine (SPAQ), used in seasonal malaria chemoprevention (SMC) campaigns, increased after the fourth phase of the SMC campaign, which is not unusual.

Health financing

As of January 2017, the country had three financing mechanisms:[5]

  • Government-financed health services,
  • the National Social Security Fund (Caisse Nationale de Sécurité Sociale, CNSS) for the formal sector,
  • and Community Based Health Insurance (CBHI) for the informal sector.

These mechanisms will eventually be combined into a single financing system to improve efficiency.[5]

Burkina Faso aims to achieve Universal Health Coverage (UHC) by 2025.

Severe malaria policy and practice

National treatment guidelines
Recommendation Treatment
Strong Injectable artesunate
Alternative Injectable artemether
Alternative Intramuscular artemether (in private health facilities capable of providing severe malaria treatment)

*Injectable artesunate and artemether is not recommended for use during the first trimester of pregnancy. 

Recommendation Treatment

Pilot in three districts in North and Sahel regions, where malaria mortality is the highest.

ARC for children under five years of age
Pregnancy
Recommendation Prevention
Strong

Sulfadoxine-pyrimethamine
(intermittent preventive treatment)

Severe malaria kits

Severe malaria cases in children under 5 and pregnant women are provided with free emergency kits

  • ~200,000 free treatment kits/year not including diagnosis

Contents:

  • Injectable artesunate or artemether or quinine
  • Injectable paracetamol
  • Diazepam
  • Glucose solution
  • Intranule catheter
  • Infusion set
  • Syringe
  • Glove
  • Tape

Severe malaria treatment kits have contributed to malaria mortality reduction from 3.3 percent of malaria cases (2011) to 1.2 percent (2015)