Senegal

Photo: Adolescent girl

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

Malaria is endemic throughout Senegal and 100 percent of the population is at risk of the disease. The number of malaria cases declined 38% from 2015–2019 (from 69 per 1000 population to 50) and the number of malaria deaths decreased 7.1% in the same period in (from 0.30 per 1000 population to 0.28).1

The Senegal 2016–2020 National Strategic Plan (NSP) states a goal of reaching the threshold for pre-elimination  – defined by the National Malaria Control Programme (NMCP) – as an annual incidence less than 5 cases per 1,000 by 2020.2

Despite improved access to and quality of malaria services in the public health sector, the rate of care seeking for febrile illness has remained stagnant (54% in 2014, 53% in 2018) among children under five years of age.2

The country can be divided into two epidemiological zones: the tropical zone in the south and southeast, with year-round transmission peaking during the rainy season and lower transmission during the rest of the year; and the Sahelian zone in the north, with higher transmission toward the end of the rainy season and very low transmission during the rest of the year.2

The national parasite prevalence decreased from 5.9 percent in 2008 to less than 1 percent in 2017.1 There are three administrative regions in the south – Tambacounda, Kolda, and Kédougou – that have the highest malaria burden, with an estimated prevalence of 1 percent, 3 percent and 7 percent, respectively.1

 

Prise en charge des cas de paludisme simple et grave

Severe and uncomplicated malaria case management

Senegal’s NMCP adopted artemisinin-based combination therapies (ACTs) as the first-line treatment in 2006 and introduced rapid diagnostic tests (RDTs) in 2007.2 Artesunate–amodiaquine, artemether–lumefantrine, and dihydroartemisinin–piperaquine are considered as co-first line ACTs, although artesunate–amodiaquine is only used in zones in which seasonal malaria chemoprevention (SMC) is not implemented. In pre-elimination zones where incidence is <5/1,000, any confirmed case of malaria is given a single low-dose of primaquine along with the ACT treatment.2

Injectable artesunate has been adopted as the first-line treatment for severe malaria at health centers, hospitals, and some rural health posts that are inaccessible during the high transmission season. Rectal artesunate as pre-referral intervention has been adopted at health posts and at the community level for children aged up to five years old.2

Artesunate-amodiaquine, artemether-lumefantrine, and dihydroartemisinin-piperaquine are considered as co-first line ACTs, though artesunate-amodiaquine is only used in zones in which SMC is not implemented.2 In pre-elimination zones where incidence is <5/1,000, any confirmed case of malaria is given a single low-dose of primaquine along with the ACT treatment.2

Universal testing for fevers became policy in 2017. RDTs are used at the health post and community level, and microscopy at higher levels. Senegal monitors antimalarial efficacy by implementing therapeutic efficacy studies in four sentinel sites each year.2

According to the 2018 NMCP annual epidemiological bulletin report, 98 percent of confirmed cases were treated with ACT. There were 520,898 ACTs consumed and 530,944 malaria cases and 2,090,323 RDTs consumed. Ninety-eight percent of suspected malaria cases were confirmed with an RDT and/or microscope.2

Health care for children under five years of age is provided free of charge at formal health facilities, which are reimbursed by the government universal health insurance scheme; however, this has not been extended to the community level.2

Household ownership of insecticide-treated mosquito nets (ITNs) increased steadily from 2005–2017 (from 20–85%), but declined in 2018 to 77%.2

Malaria in Pregnancy

In 2003, Senegal adopted intermittent preventive treatment in pregnant women, with sulfadoxine/pyrimethamine (SP) given free of charge as directly observed therapy during focused antenatal care (ANC) visits in all ANC sites nationwide.2

In 2014, the NMCP updated its policy and training materials to reflect WHO recommendations. One key recommendation supported by the NMCP is that SP is given as early as possible in the second trimester with a one-month interval between two doses of SP.2
 

Seasonal malaria chemoprevention

The Senegal NMCP has been implementing seasonal malaria chemoprevention (SMC) since it was recommended by WHO in 2012, including children up to ten years of age. Much of the existing research on SMC was conducted in Senegal, first in children under five and subsequently in children under ten.2

In 2019, the SMC campaign strategy was readjusted based on the evolving malaria epidemiology in Senegal to cover a total of 15 districts, phasing out the region of Sédiou, which has seen a significant reduction in incidence, and adding the Touba and Diourbel districts in the Diourbel region.2

Monthly dosing for three months are implemented in the Diourbel, Kolda, and Tambacounda regions, and four months in Kédougou, based on the respective length of the malaria transmission season in these regions.2

Challenges in addressing uncomplicated and severe malaria2

  • Prompt care seeking for fever in Senegal is low. While mothers consider fever to be a sign of malaria that needs to be taken seriously, men, including fathers consider fever as a benign and temporary condition.
  • Symptomatic treatment of fever by caregivers’ delays prompt care seeking and timely diagnosis & treatment of malaria
  • Availability of RDTs and ACTs remained high in public structures; unexpired RDTs were available in 97 percent of structures and unexpired ACTs were present in 61 percent of structures (93% of public structures and 10% of private structures). The 2018 continuous Demographic and Health Survey (cDHS) found that while care had been sought for 53 percent of children under five years of age with fever in the two weeks before the survey, the vast majority in the public sector, only 14 percent of these febrile children had received an RDT.
  • In 2018, 98 percent of pregnant women attended at least one ANC visit by a skilled provider. However, only 64 percent of pregnant women attended their first ANC during the first trimester and 59 percent four ANC visits or more. Regular ANC compliance remains a challenge in Senegal.

Malaria epidemiological situation in Senegal

Image: Malaria epidemiological situation in Senegal

Severe malaria admissions and deaths in Senegal

Image: Severe malaria admissions and deaths in Senegal

Severe malaria policy and practice

National treatment guidelines

Recommendation

Treatment

Strong

IV artesunate

 

Recommendation

Pre-referral

Health posts

Rectal artesunate

Community level

Rectal artesunate

 

Pregnancy

Recommendation

Protection

IPTp

Sulfadoxine/pyrimethamine (3 doses)