Déploiement d’une nouvelle stratégie de traitement d’une maladie à transmission vectorielle : application au paludisme, analyse des pratiques thérapeutiques, et conséquences sur l’épidémiologie de P. falciparum en Casamance, Sénégal, 1996 – 2009

[mplementation of a new treatment strategy for a vector-born parasitic disease : the malaria case, therapeutic practices and consequences on the epidemiology of P. falciparum malaria in Casamance, Senegal, 1996-2009]
Malaria remains a major health burden for mankind despite trends towards a decrease in the number of cases in most endemic areas. The research summarized in this thesis concerns the deployment of an artemisinin-containing antimalarial drug combination (ACT) in a rural district of moderately intense transmission. The choice of an adapted treatment must be evidence based. Systematic reviews and meta-analysis are considered the most robust form of evidence. However, visual displays should be improved in order to improve decision making.Furthermore, to complement evidence from clinical trials, drugs should be studied when used in real-life conditions and followed-up over time for their efficacy, safety, parasite susceptibility, quality of case management, malaria epidemiology.A pilot programme to change case management modalities was started in 2000 in Mlomp, Senegal. The programme was embedded in the public health system and aimed at replacing the previous policy (single-agent treatment on clinical grounds) with the new policy (ACT for parasitologically confirmed malaria). The work conducted to support the scaling-up of the new policy allows improving case management and provides elements towards a better understanding of obstacles to the deployment of the new strategy and its effects on the health of populations.