Flow diagram.

<p>Flow diagram.</p

Coverage of SMC defined as the proportion of children who received all three days of SMC treatment according to the method of delivery (door to door versus fixed point) in 2014.

<p>Coverage of SMC defined as the proportion of children who received all three days of SMC treatment according to the method of delivery (door to door versus fixed point) in 2014.</p

Mother's opinion on SMC according to the method of delivery (door to door versus fixed point) and the method of observation of the treatment (directly observed treatment versus not directly observed treatment).

<p>Mother's opinion on SMC according to the method of delivery (door to door versus fixed point) and the method of observation of the treatment (directly observed treatment versus not directly observed treatment).</p

Proportions of children who received none, at least one, or at least two rounds of SMC according to the method of observation of the treatment (directly observed treatment versus not directly observed treatment).

<p>Proportions of children who received none, at least one, or at least two rounds of SMC according to the method of observation of the treatment (directly observed treatment versus not directly observed treatment).</p

Coverage of SMC defined as the proportion of children who received all three days SMC treatments according to the method of observation of the treatment, directly observed treatment versus not directly observed treatment.

<p>Coverage of SMC defined as the proportion of children who received all three days SMC treatments according to the method of observation of the treatment, directly observed treatment versus not directly observed treatment.</p

Proportions of children who did not receive any round of SMC, who received at least one round, and who received at least two rounds, according to the method of delivery (door to door versus fixed point).

<p>Proportions of children who did not receive any round of SMC, who received at least one round, and who received at least two rounds, according to the method of delivery (door to door versus fixed point).</p

Baseline Characteristics of the study subjects.

<p>Baseline Characteristics of the study subjects.</p

Mean prevalence according to the age groups.

<p><b>*</b> Significant difference between the prevalence of individuals higher than 18years and other groups.</p

Mean prevalence according to the age groups.

<p><b>*</b> Significant difference between the prevalence of males obtained by PCR and that observed among females.</p

Marked Rise in the Prevalence of Asymptomatic <i>Plasmodium falciparum</i> Infection in Rural Gabon

<div><p>Control strategies implemented a decade ago led to a marked reduction in the prevalence of malaria in many countries. In Dienga, southeastern Gabon, the prevalence of microscopic <i>P</i>. <i>falciparum</i> infection was 7% in 2003, close to the pre-elimination threshold of 5%. The aim of this work was to determine the prevalence of <i>P</i>. <i>falciparum</i> infection in the same community a decade later. A cohort of 370 individuals aged from 3 to 85 years living in Dienga was investigated for <i>P</i>. <i>falciparum</i> infection; during six passages (P) in 15-month period. Demographic data were collected, along with behaviors and attitudes towards malaria. <i>Plasmodium</i> infection was diagnosed by microscopy (ME), followed by PCR to detect submicroscopic infection. The prevalence of <i>P</i>. <i>falciparum</i> infection in P1, P2, P3, P4, P5 and P6 was respectively 43.5% (25.1% ME+, 18.4% PCR+); 40.9% (27.0% ME+, 13.9% PCR+), 52.7% (26.1% ME+, 26.6% PCR+); 34.1% (14.1% ME+, 20% PCR+), 57.7% (25.4.% ME+, 32.3% PCR+); and 46.2% (21.4% ME+, 24.8% PCR+) with an overall average of 45.9% (95%CI [37.0–54.7], 23.2% ME+ and 22.7% PCR+). P4 and P5 prevalences were statically different throughout the six passages. Microscopic prevalence was significantly higher than that observed ten years ago (23% [n = 370] vs 7% [n = 323], p < 0.001). Asymptomatic infections were the most frequent (96%). Gametocytes were detected in levels ranging from 5.9% to 13.9%. Insecticide-treated nets, indoor residual insecticides, and self-medication were used by respectively 33.2% (95%CI [29.0–37.4]), 17.7% (95%CI [15.5–19.9]) and 12.1% (95%CI [10.6–13.6]) of the study population. A near-threefold increase in <i>P</i>. <i>falciparum</i> infection has been observed in a rural area of southeastern Gabon during a 10-year period. Most infections were asymptomatic, but these subjects likely represent a parasite reservoir. These findings call for urgent reinforcement of preventive measures.</p></div