Guinea

Malaria facts and situation

Photo: Little girl Guinea

Malaria is endemic throughout Guinea, and the country is among the 17 highest burden malaria countries in the world (2% of all global malaria cases and deaths in 2019 [1]).

The country has made important progress in malaria control and prevention, substantially reducing malaria prevalence in children under 5, annual malaria incidence, and in-patient deaths. Between 2016 and 2019, the case burden for malaria fell by 12.6% (from 340 to 297 per 1000 of the population at risk), while deaths fell by 12% (from 0.73 to 0.64 per 1000 of the population at risk. [1]

These gains were driven by the rapid scale-up of malaria prevention and control interventions, led by the country’s National Malaria Control Programme (NMCP) and supported by the US President’s Malaria Initiative (PMI) and the Global Fund to Fight AIDS, Tuberculosis and Malaria.

There are two areas in Guinea where malaria is endemic (MICS 2016): a moderate transmission area, which covers five regions of the country and 63 % of the general population, and a low transmission area, which covers three regions, including the capital Conakry and 37 % of the population. [2]

The major vector of malaria is Anopheles gambiaes sensu lato, which is found throughout the country, with its density peaking in the rainy season, from June to October. The dominant plasmodium species is Plasmodium falciparum, at 96.5 %; P. malariae and P. ovale represent 3.3 % and 0.13 %, respectively. [2]

The percentage of malaria infections in children under 5 years and pregnant women between 2017 and 2019 were 37.3 % and 3.9 %, respectively. [2] According to routine NMCP data, the, compared with overall malaria morbidity. According to the 2018 DHS, 30 % of children under 5 years are stunted and 9 % are acutely malnourished, while 46 % of women of childbearing age are anaemic. [2]

Furthermore, people who face difficulties in accessing health services are groups at increased risk of malaria. These include mobile populations and people who live in isolated areas or a long way from health care facilities. These groups include populations living in the mining areas of Kankan and Faranah, and the communities who live around the coastal areas. [2]

Prevention of malaria

Between 2012 and 2016, there were significant improvements in the use of insecticide-treated nets (ITNs) by vulnerable populations. The use by children under five years increased from 26% to 68% and use by pregnant women from 28% to 70%. [3] However, a dramatic decline in use was observed between 2016 and 2018 – household ownership fell from 84% to 44%, and the use by vulnerable populations returned to 2012 levels.[3]

This decline may be due, in part, to the timing of mass ITN distribution campaigns in relation to the timing of data collection for the surveys (the 2016 survey was conducted after an ITN campaign and the 2018 survey was conducted right before an ITN campaign). [3] Some level of ITN attrition is expected over the three-year interval between campaigns as ITNs get worn and torn and/or repurposed. Nonetheless, the drastic decline in ownership between 2016 and 2018 is worrisome and may indicate a need for improvement in continuous ITN distribution systems. [3]

Guinea began implementing seasonal malaria chemoprevention (SMC) in 2015 in six health prefectures in the northern part of the country, representing a total population of 2.2 million. [3] The number of prefectures has gradually been expanded and is currently implemented in 13 districts currently found to be meeting the criteria for the implementation of SMC (chosen by the NMCP). The SMC activities in eight of the prefectures are supported by PMI, while the other 5 are supported by the Global Fund. [3]

SMC implementation in Guinea comprises four cycles of the distribution of amodiaquine and sulfadoxine-pyrimethamine (AQ+SP) to all children 3–59 months old. Each cycle of distribution lasts between four and five days and is done on a monthly basis between July and October, representing the highest transmission period in the area. [3]

Malaria in pregnancy

Guinea’s national strategic plan has a 2022 target of at least 60% of pregnant women receiving at least three doses of sulfadoxine-pyrimethamine (SP) doses of intermittent preventive treatment in pregnancy (IPTp3) to prevent malaria throughout their pregnancy. [3]

Progress has been made towards this target: the percentage of women who received two or more doses of IPTp during their last pregnancy in the last two years increased from 49% to 62% between 2016–18, while those who received three or more doses increased from 30–36% in the same period. [3]

The national strategy states that all cases of severe malaria in pregnant women should be treated with parenteral quinine during the first trimester of pregnancy, and intramuscular injection of artemisinin derivatives or parenteral quinine from the second trimester onward. The strategy also follows WHO guidance regarding pregnant women who are HIV-positive. [3]

National treatment guidelines
Recommendation Treatment
Strong Injectable artesunate (IV or IM)
Alternative Intramuscular artemether
Alternative Injectable quinine
Recommendation Pre-Referral
Alternative Rectal artesunate
   
Pregnancy
Recommendation Prevention
Strong

Sulfadoxine-pyrimethamine
(intermittent preventive treatment)