Recul et persistance du paludisme en Union des Comores : une approche géographique pour déterminer l’importance des facteurs environnementaux et sociaux dans son maintien

Abstract : Malaria has been present in the Comoros archipelago since 1925, when a major epidemic was first recorded in Grande Comore. The islands have been favourable to the development of vectors causing malaria transmission (Anopheles gambiae and Anopheles funestus) due to the high tropical rainfall, high hydrographic density, the suitable environment with forests and wetlands, as well as the construction of water reservoirs in households. This disease has been endemic since the 1970s and a major public health problem until the 2000s. From the end of the 1990s, the Comorian government has decided to implement a strategy to control malaria by anti-malaria vector control and population protection against mosquito bites. In the last twenty years, malaria control efforts have been intensified and for a first time, mass treatment with Artequick has been carried out in Mohéli (2007-2009), Anjouan (2012-2013) and Grande Comore (2013). There has since been a dramatic decline in malaria on all the islands, as Mohéli and Anjouan have entered a pre-elimination phase and Grande Comore is in the control phase. In the first part, this thesis describes the spatial and temporal dynamics of malaria before and after mass treatment in order to understand the impact of different control actions. A mapping of hospital prevalence and incidence of malaria at the district and village levels shows its decline in Anjouan and Mohéli and its persistence in Grande Comore. Spatial autocorrelation tests have revealed a similarity in malaria transmission between neighbouring localities that are forming clusters in Grande Comore. In the second part, it was demonstrated that environmental factors have an influence on malaria transmission, despite the greater importance of control actions. At the district level, simple and multiple linear regression models have been established between the incidence of malaria and land cover / land use patterns of islands and landscape indicators at the village level in Grande Comore. A survey on people's knowledge, practices and vulnerabilities was conducted among 1,288 households in the Union of the Comoros to assess factors of vulnerability that contribute to malaria transmission. Beyond having water reservoirs in households, the waste disposal location would also have an impact on malaria in Grande Comore. The survey revealed that several households on the large island did not take the 2013 mass treatment. This thesis provides a better understanding of the human and environmental aspects of malaria maintenance and thus aims to better target future control actions.
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Attoumane Artadji. Recul et persistance du paludisme en Union des Comores : une approche géographique pour déterminer l’importance des facteurs environnementaux et sociaux dans son maintien. Géographie. Université de la Réunion, 2019. Français. ⟨NNT : 2019LARE0003⟩. ⟨tel-02172231⟩

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