Bayesian spatial modelling of malaria burden in two contrasted eco-epidemiological facies in Benin (West Africa): call for localized interventions.

BACKGROUND: Despite a global decrease in malaria burden worldwide, malaria remains a major public health concern, especially in Benin children, the most vulnerable group. A better understanding of malaria's spatial and age-dependent characteristics can help provide durable disease control and elimination. This study aimed to analyze the spatial distribution of Plasmodium falciparum malaria infection and disease among children under five years of age in Benin, West Africa. METHODS: A cross-sectional epidemiological and clinical survey was conducted using parasitological examination and rapid diagnostic tests (RDT) in Benin. Interviews were done with 10,367 children from 72 villages across two health districts in Benin. The prevalence of infection and clinical cases was estimated according to age. A Bayesian spatial binomial model was used to estimate the prevalence of malaria infection, and clinical cases were adjusted for environmental and demographic covariates. It was implemented in R using Integrated Nested Laplace Approximations (INLA) and Stochastic Partial Differentiation Equations (SPDE) techniques. RESULTS: The prevalence of P. falciparum infection was moderate in the south (34.6%) of Benin and high in the northern region (77.5%). In the south, the prevalence of P. falciparum infection and clinical malaria cases were similar according to age. In northern Benin children under six months of age were less frequently infected than children aged 6-11, 12-23, 24-60 months, (p < 0.0001) and had the lowest risk of malaria cases compared to the other age groups (6-12), (13-23) and (24-60): OR = 3.66 [2.21-6.05], OR = 3.66 [2.21-6.04], and OR = 2.83 [1.77-4.54] respectively (p < 0.0001). Spatial model prediction showed more heterogeneity in the south than in the north but a higher risk of malaria infection and clinical cases in the north than in the south. CONCLUSION: Integrated and periodic risk mapping of Plasmodium falciparum infection and clinical cases will make interventions more evidence-based by showing progress or a lack in malaria control.

Traditional knowledge and cultural importance of Borassus aethiopum Mart. in Benin: interacting effects of socio-demographic attributes and multi-scale abundance.

BACKGROUND: Eliciting factors affecting distribution of traditional knowledge (TK) and cultural importance of plant resources is central in ethnobiology. Socio-demographic attributes and ecological apparency hypothesis (EAH) have been widely documented as drivers of TK distribution, but their synergistic effect is poorly documented. Here, we focused on Borassus aethiopum, a socio-economic important agroforestry palm in Africa, analyzing relationships between the number of use-reports and cultural importance on one hand, and informant socio-demographic attributes (age category and gender) on the other hand, considering the EAH at multi-scale contexts. Our hypothesis is that effects of socio-demographic attributes on use-reports and cultural importance are shaped by both local (village level) and regional (chorological region level) apparency of study species. We expected so because distribution of knowledge on a resource in a community correlates to the versatility in the resource utilization but also connections among communities within a region. METHODS: Nine hundred ninety-two face-to-face individual semi-structured interviews were conducted in six villages of low versus high local abundance of B. aethiopum spanning three chorological regions (humid, sub-humid and semi-arid) also underlying a gradient of increasing distribution and abundance of B. aethiopum. Number of use-reports and score of importance of uses of B. aethiopum were recorded in six use-categories including medicine, food, handcraft, construction, firewood, and ceremonies and rituals. Data were analyzed using Poisson and ordered logistic models. RESULTS: Informants listed 121 uses for B. aethiopum: medicine (66 uses), handcraft (16 uses), food (16 uses), construction (12 uses), firewood (6 uses), and ceremonies and rituals (5 uses); but food use was the most culturally important use (2.45 ± 0.03), followed by construction (0.61 ± 0.03), medicinal (0.57 ± 0.03) and handcraft (0.56 ± 0.03), firewood (0.29 ± 0.02), and ceremonies and rituals (0.03 ± 0.01). Food use was the most important for women who were specialized in hypocotyls and fruits collection for commercialization. Men valued more the species for handcrafting, construction, and medicine. The number of use-reports was significantly dependent on age category and gender, and differences between age categories (young, adult, and old) in particular were dependent upon local and regional apparency. In particular, discrepancies among age categories were higher in areas of low abundance and distribution, which may be linked to different speed in the process of knowledge acquisition. In areas of low abundance, the species past abundance was also found instrumental in understanding current knowledge distribution. CONCLUSION: Findings suggest that studies aiming at understanding relationship between current TK and cultural importance of a resource on one hand and socio-demographic attributes on the other hand should consider the resource current local and regional apparency but further its local past abundance. The study also confirms that B. aethiopum is a socio-economic important species in Benin.