Within BPH, Shino Arikawa explored the effectiveness of malaria chemoprevention in Togo.
Shino Arikawa, chercheur·e au sein de BPH (Université de Bordeaux).
Thèse soutenue en 2025 à l'école doctorale Sociétés, Politique, Santé Publique.
Référencée dans le réseau ABES/STAR, cette thèse répond aux critères de rigueur de l'enseignement supérieur français.
The fight against malaria in Togo requires an integrated and pragmatic approach, taking into account local realities and the specific challenges the country faces. Shino Arikawa's thesis, conducted at the University of Bordeaux, highlights the challenges and opportunities related to the long-term malaria chemoprevention (CPP) in the Haho district, a region particularly affected by this disease. By integrating chemoprevention into the expanded vaccination program, the study aims to assess its effectiveness in real-world conditions, which is crucial for the implementation of appropriate public health policies.
The results of the study are concerning and raise fundamental questions about access to healthcare. Indeed, 16% of children under two years old have not received routine vaccinations, and 12.6% of children aged 16 to 23 months remained unimmunized after two years of project implementation. These alarming figures highlight the importance of improving access to healthcare for vulnerable children, often referred to as 'zero dose'. These children, who have not received basic vaccinations, are particularly exposed to the risks of preventable diseases, including malaria.
The methodology adopted by Arikawa is based on cohort analyses, allowing for the assessment of malaria burden and vaccination coverage. This methodological approach is essential for understanding the dynamics of the disease and identifying the most at-risk groups. The results show that chemoprevention can be effective, but it requires strategic adjustments to reach the most vulnerable populations. For example, targeted awareness campaigns could be implemented to inform families about the importance of vaccination and chemoprevention.
The recommendations from this study include strengthening community engagement strategies to reach unvaccinated children. This could involve training community relays who would be responsible for raising awareness among parents and encouraging them to vaccinate their children. Furthermore, an adaptation of CPP programs is necessary to maintain coverage during periods of high transmission, which often coincide with the rainy seasons.
It is imperative to strengthen data collection to inform public health policies. Improved data collection would not only allow for tracking the evolution of vaccination coverage but also identify the geographical areas most affected by malaria. Arikawa's thesis calls for a collaborative approach, integrating local actors and policymakers, in order to effectively combat malaria in Togo.
This collaboration is all the more necessary in the context of West Africa, where malaria remains one of the leading causes of infant mortality. Indeed, similar initiatives in other countries in the region, such as Benin or Ghana, have shown that community engagement and family participation are key success factors.
The implementation of these recommendations could transform the public health landscape in the country, reducing the incidence of malaria and improving vaccination coverage. Ultimately, it is about ensuring a healthier future for the children of Togo by providing them with the necessary protections against preventable diseases. The fight against malaria should not be seen merely as a health issue, but as a socio-economic development challenge, as the health of children is intrinsically linked to the future prosperity of the country.
Données clés
- 16% : proportion d'enfants de moins de deux ans non vaccinés dans le district de Haho.
- 12.6% : pourcentage d'enfants non immunisés après deux ans de mise en œuvre du projet.
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Sources et accès
Shino Arikawa. Effectiveness of perennial malaria chemoprevention : insights from an implementation research project in Southern Togo. Human health and pathology. Université de Bordeaux, 2025. English. ⟨NNT : 2025BORD0211⟩. ⟨tel-05457581⟩