According to the World Health Organization (WHO), approximately 3.3 billion people, nearly half of the world population, are at risk of malaria. Each year, approximately 250 million people contract the disease, and nearly one million people die. The inhabitants of the poorest countries are the most vulnerable. More than one in five infant deaths (20%) occurring in Africa are due to malaria
. However, the number of Plasmodium falciparum malaria cases is declining, even in Africa. Given this situation, in the late 1990s, WHO proposed a goal of controlling the disease and achieving elimination by 2015 in areas of low transmission. Policies, international and national initiatives have proliferated to help the neediest.
Based on the results of scientific research in all areas of malaria control and because of greater knowledge of the disease and its medical and social consequences, the proposed strategy is organized into two main phases: control and disposal
. Among the actions undertaken on a large scale, it should be noted that the availability and distribution of ITNs and ACT, vector control through IRS, active detection of new breeding sites and their systematic destruction represent a link essential to the success of disease control before disposal is considered
According to the Roll Back Malaria project, malaria primarily concerns 109 countries, but 35 countries account for 98% of malaria deaths worldwide. Only five of these countries (Nigeria, Democratic Republic of Congo, Uganda, Ethiopia and Tanzania) represent 50% of deaths and 47% of malaria cases
. Among these countries, Ethiopia and Uganda share an economic community, bringing together 340 million people who are free to move to the Republic of Djibouti
Formerly known to be a malaria meso- to hypoendemic country with an unstable malaria transmission profile
[6–8], this country of 818,159 inhabitants declared a goal of malaria pre-elimination in 2006
. Micro-epidemics can occur in the presence of favourable set of conditions, such as unusual rainfall (the last major outbreak occurred in 1999)
[10, 11]. Over the last 14 years, the transmission and the malaria cases number remained low. As a result, foreign armies present in the Republic of Djibouti have recently considered stopping their malaria chemoprophylaxis
, as the French army did last year.
Djibouti has recently demonstrated its eligibility for the pre-elimination goal according to technical feasibility, i.e., the baseline domestic malaria transmission combined with the importation-related transmission and operational feasibility, which takes into consideration the country government status, health status and information on populations at risk
. These observations are in agreement with parasite genetic diversity studies
[10, 11], and one recent work has reported a low transmission level
According to WHO, malaria control requires, at a national level, the expertise and development of databases containing information about the parasites found locally and information about changes in transmission levels and the status of resistance to anti-malarials
. Control in the short- and medium-term is possible by developing constantly improved detection and observation tools and early care and adequate diagnoses in risk populations
Therefore, serological tools are widely used to assess the transmission level and thus the prevalence of Plasmodium falciparum and Plasmodium vivax in human populations and to assess epidemiological facts of the past and present
[16, 17]. One recent work in Somaliland (the nearest neighbouring country to Djibouti with regular movements of the population in both directions) has used serological tools to assess the prevalence of P. falciparum and P. vivax[18–20].
Starting from this observation, it was necessary to perform a similar survey in the Republic of Djibouti. Because most of the previous studies have primarily concerned P. falciparum malaria, it was also necessary to study P. vivax malaria and mixed infections to gather enough information for elimination
The aim of the present study was to evaluate the prevalence rate of P. falciparum, P. vivax and mixed infections in the Djiboutian population by using serological tools and to identify potential determinants of hot spots of malaria infection and transmission within the country.