Oasis Malaria, Northern Mauritania1

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A malaria survey was conducted in Atar, the northernmost oasis city in Mauritania, during 2015-2016.All febrile patients in whom malaria was suspected were screened for malaria by using rapid diagnostic testing and microscopic examination of blood smears and later confirmed by PCR.Of 453 suspected malaria cases, 108 (23.8%) were positive by rapid diagnostic testing, 154 (34.0%) by microscopic examination, and 162 (35.7%) by PCR.Malaria cases were observed throughout the year and among all age groups.Plasmodium vivax was present in 120/162 (74.1%) cases, P. falciparum in 4/162 (2.4%), and mixed P. falciparum-P.vivax in 38/162 (23.4%).Malaria is endemic in northern Mauritania and could be spreading farther north in the Sahara, possibly because of human-driven environmental changes.Further entomologic and parasitologic studies and monitoring are needed to relate these findings to major Anopheles mosquito vectors and to design and implement strategies for malaria prevention and control.M alaria is one of the major reasons for seeking health- care in public health facilities in Mauritania.In 2016, among an estimated population of 3,537,368, malaria incidence was 78/1,000 persons at risk (1) and malariaassociated mortality was 30 deaths/100,000 persons (2).The northern limit where malaria transmission occurs in Mauritania is not well defined.Sporadic suspected cases of malaria were reported in the oasis setting of Atar in the early 2010s, and the first Plasmodium vivax cases were confirmed by microscopic examination in 2012, but PCR was not performed for further confirmation (A.Ould Mohamed Salem Boukhary, unpub.data).Therapeutic efficacy of chloroquine to treat P. vivax malaria was also evaluated in 2013 in Atar (3).In that study, patient screening and recruitment were performed during only 1 month, followed by a 28-day follow-up period.Here, we report results of a follow-up study in which we conducted a longitudinal survey in Atar to establish baseline data on malaria burden in this Saharan zone of Mauritania. Materials and Methods Study SiteDuring March 2015-December 2016, we conducted a longitudinal study in the Hospital Center of Atar, situated in the regional capital of Adrar Province, northern Mauritania (Figure 1).Atar is the largest oasis city located in the Sahara, ≈440 km to the northeast of Nouakchott, the national capital.According to the latest census of population and housing, the population of Atar in 2013 was 38,803, primarily Moors (1).Rainfall in Atar is scarce (annual mean 50 mm; Office National de la Météorologie, Nouakchott, pers.comm., 2018 Feb 4).During the study period, the total amount of rainfall was 79.2 mm in 2015 and 65 mm in 2016.The average temperature during the same period was 29.5°C (range 23°C-36°C), and the mean relative humidity was 37.1% (range 20%-54%).Date palm culture is the main agricultural activity in Adrar Province; ≈1,200,000 palm trees are distributed across 75 oases (4).Livestock largely consists of dromedary camels (Camelus dromedarius) and small ruminants (goats and sheep).

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