Burkina Faso

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 (3.3% of global malaria cases and 3.4% of global malaria deaths in 2021).[1] Malaria is responsible for 43% of health provider consultations and 22% of deaths. The country accounted for an estimated 7% of total malaria cases in West Africa in 2020. [1] 

Mortality rates fell by 13.7% between 2020 and 2021 – from 0.99 to 0.86 per 1000 of the population at risk. Case numbers remained stable from 2020 to 2021 at 377 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] 

Malaria is endemic throughout Burkina Faso, and the country is one of 11 “high-burden high-impact countries” which bear 70 percent of the world’s malaria burden. 

Seasonal peaks occur between May and October and vary in timing and intensity across the country’s three major geographic zones due to regional differences in the rainy season. 

Transmission is continuous throughout the year, with two seasonal peaks producing epidemic outbreaks from March to May and October to December.  

Malaria prevalence in children under 5 years of age increased from 17.3 percent in 2012 to 27 percent in 2017, an increase of 10 percent over five years.  

There are clear disparities in access to health services between populations living in urban and rural areas and those on very low incomes. The barriers identified include financial, geographical, and sociocultural obstacles and population mobility.   The prevalence of malaria in children decreases as their mother’s level of education increases. 31 percent of children whose mothers had no education tested positive on microscopic examination. Where the mother has completed high school or higher education, prevalence falls to 11 percent.   

Key interventions highlighted by the NMCP’s NSP include a provision of an ITN to all pregnant women at the time of their first antenatal care (ANC) visit, provision of four or more doses of sulfadoxine-pyrimethamine (SP) as intermittent preventive treatment for pregnant women (IPTp), and effective case management of diagnosed malaria per WHO guidelines. According to the NMCP, 89 percent of pregnant women received an ITN and 65 percent received three or more doses of IPTp in 2021, which falls short of the complete coverage aspiration of the NMCP. [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 and children 

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. 

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] 

In 2020, out of the number of severe malaria cases in children under five expected to be transferred from the community level, only 10.24 percent were transferred. In 2019 and 2020, pre-referral management was in pilot phase in four districts in the Sahel region and six districts in the Centre-North region. In 2021 and 2022, the pilot phase was to be extended to 25 districts in four other regions (Boucle du Mouhoun, Centre-East, East, and North). The expected percentage of severe malaria cases requiring pre-referral management is estimated at 47.39 percent in 2021 and 2022. [2] 

In 2023, pre-referral management will be extended to all districts nationwide and it is assumed that 100 percent of the expected severe malaria in children under five at the community level will be managed with a pre-referral intervention.[2] 

Seasonal malaria chemoprevention 

The current national strategy for seasonal malaria chemoprevention (SMC) is to target relevant geographic areas and age groups, which includes four or five rounds of SMC for children 3 to 59 months of age in all 70 districts, in accordance with WHO recommendations.[2] 

In 2020, PMI supported SMC in 12 districts, protecting approximately 4.1 million children under five years of age, and obtaining an administrative coverage rate of 105 percent, as more children were reached than originally targeted. Despite the COVID-19 pandemic, the SMC campaign took place on time across the country with minimal challenges.[2] In 2022, PMI , the Global Fund, Malaria Consortium, and UNICEF will support SMC activities in Benin .[2] 

Burkina Faso is part of the OPT-SMC programme which implements operational research within SMC implementation. Concerns have been raised by the NMCP and others about possible reductions in the impact of SMC on preventing malaria infection in the target population. Several partners are supporting the NMCP to better understand whether the effectiveness of SMC is decreasing. 

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. 

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.