La Cote d'Ivoire

Malaria facts

Photo: Mother and child with medical doctor

Malaria prevalence, cases, map, treatment, risk and deaths

Malaria is endemic in Côte d’Ivoire and the entire population is at risk of contracting the disease. Transmission occurs throughout the year, with peak incidence in April to July.1  

Progress in malaria prevention and control has stagnated in recent years, with the estimated number of cases increasing 15.8% between 2015 and 2018 (from 260 cases per 1000 population to 300 per 1000). However, the number of malaria-related deaths have stagnated ain the same period (from 0.414 per 1000 population to 0.416).2

The national strategy for malaria prevention in pregnancy includes provision of insecticide-treated mosquito nets (ITNs) at the first antenatal care visit, and intermittent preventive treatment for pregnant women (IPTp) in malaria-endemic area starting at 13 weeks gestational age, for a minimum of three doses.1 

The resistance level of the major vector, Anopheles gambiae s.l., to the insecticides used to impregnate mosquito nets is significant throughout the country and ranges from 39–95% for permethrin, 75–100% for deltamethrin, and 50–100% for alpha-cypermethrin in areas that have been studied.1 

Severe malaria case management

The National Malaria Control Program (NMCP) in Côte d’Ivoire was established in 1996. The current national strategic plan, Plan Stratégique National de Lutte Contre le Paludisme 2016- 2020 (NMSP) was adopted in 2016. The main objectives of the NMSP 2016-2020 are to reduce both malaria incidence and malaria-related mortality by 40% by 2020 compared to 2015 baselines.1

Microscopy is used to confirm malaria diagnosis in the public and private-not-for-profit (faith-based) sectors at all regional and district reference hospitals. Rapid diagnostic tests (RDTs) are used to confirm malaria diagnosis at health centers and at the community level, or in any health care facility whenever microscopy is unavailable.2

The first-line treatment for severe malaria is intravenous (IV) or intramuscular (IM) artesunate; the first-line treatment for severe malaria in pregnancy is IV quinine. At peripheral health facilities, pre-referral treatment of severe disease with IM artesunate or IM artemether is recommended. For community health workers, pre-referral treatment of severe disease in under 5s with rectal artesunate (50 mg) is recommended.2

There is no fee for RDTs or artemisinin-based combination therapies (ACTs) in public and private not-for- profit health facilities for children under 5 years of age and pregnant women.2 Emergency diagnosis and treatment (which includes severe malaria) are free of charge for patients of all ages.2 For older children and adults, all RDTs and ACTs are provided free of charge in public health facilities.2 RDTs and ACTs should be provided free of charge in private for-profit facilities for children under 5 years of age and pregnant women, although this may not always occur.2

Malaria control interventions

The national strategy for malaria prevention in pregnancy includes provision of insecticide-treated mosquito nets (ITNs) at the first antenatal care visit, and intermittent preventive treatment for pregnant women (IPTp) in malaria-endemic area starting at 13 weeks gestational age, for a minimum of three doses.2

The resistance level of the major vector, Anopheles gambiae s.l., to the insecticides used to impregnate mosquito nets is significant throughout the country and ranges from 39–95% for permethrin, 75–100% for deltamethrin, and 50–100% for alpha-cypermethrin in areas that have been studied.2

Health care facilities

In Côte d’Ivoire, a significant proportion of the population seeks care in the private sector. According to the 2016 Multiple Indicator Cluster Survey (MICS), 13.5 percent of children under 5 years of age with fever presented to private facilities for care, while another 38.5 percent did not seek treatment at all.3

Challenges in addressing uncomplicated and severe malaria

  • Although malaria is the number one reason people are seen in health facilities, immediate health seeking for children is still delayed. Only about 63 percent of children under 5 with fever are brought to a health facility or community health worker as a first recourse within 24 hours.2
  • Providers may default to the older strategy of treating fever cases as presumptive malaria even when there is no documented positive diagnostic test.2
  • Among pregnant women who received sulfadoxine/pyrimethamine from a source other than a health center, 75.4% reported paying for the drug, while 24.3% of women who received their dose only from a health center reported paying for the drug.2
  • Côte d’Ivoire's supply chain faces major challenges. Supply chain reform in 2014 significantly improved commodities storage and distribution from the Central Medical Store to the district level. At the district level, however, challenges remain with regards to the distribution of commodities to health facilities.2

Cote dIvoire malaria epidemiological profile

Côte d'Ivoire epidemiological profile

Severe malaria admissions and deaths in Cote dIvoire

Severe malaria admissions and deaths in Cote dIvoire: World Malaria Report 2018

Severe malaria policy and practice

National treatment guidelines

Recommendation
Treatment

Strong

IV/IM artesunate

 

Recommendation
Pregnancy

Strong

IV quinine

 

Recommendation
Pre-referral

Peripheral health facilities

IM artesunate or IM artemether

Community level

Rectal artesunate

 

Pregnancy
Recommendation
Protection

IPTp

Sulfadoxine/pyrimethamine (3 doses)

Sources of malaria financing in La Cote DIvoire

Cote dIvoire sources of financing: World Malaria Report 2018