{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T05:52:01Z","timestamp":1790833921168,"version":"4.1.0"},"reference-count":64,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2020,1,8]],"date-time":"2020-01-08T00:00:00Z","timestamp":1578441600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Burkina Faso has recently implemented an additional strategy, the free healthcare policy, to further improve maternal and child health. This policy targets children under five who bear the brunt of the malaria scourge. The effects of the free-of-charge healthcare were previously assessed in women but not in children. The present study aims at filling this gap by assessing the effect of this policy in children under five with a focus on the induced spatial and temporal changes in malaria morbidity. We used a Bayesian spatiotemporal negative binomial model to investigate the space\u2013time variation in malaria incidence in relation to the implementation of the policy. The analysis relied on malaria routine surveillance data extracted from the national health data repository and spanning the period from January 2013 to December 2018. The model was adjusted for meteorological and contextual confounders. We found that the number of presumed and confirmed malaria cases per 1000 children per month increased between 2013 and 2018. We further found that the implementation of the free healthcare policy was significantly associated with a two-fold increase in the number of tested and confirmed malaria cases compared with the period before the policy rollout. This effect was, however, heterogeneous across the health districts. We attributed the rise in malaria incidence following the policy rollout to an increased use of health services combined with an increased availability of rapid tests and a higher compliance to the \u201ctest and treat\u201d policy. The observed heterogeneity in the policy effect was attributed to parallel control interventions, some of which were rolled out at different paces and scales. Our findings call for a sustained and reinforced effort to test all suspected cases so that, alongside an improved case treatment, the true picture of the malaria scourge in children under five emerges clearly (see the hippopotamus almost entirely).<\/jats:p>","DOI":"10.3390\/ijerph17020417","type":"journal-article","created":{"date-parts":[[2020,1,9]],"date-time":"2020-01-09T03:07:11Z","timestamp":1578539231000},"page":"417","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Effect of Free Healthcare Policy for Children under Five Years Old on the Incidence of Reported Malaria Cases in Burkina Faso by Bayesian Modelling: \u201cNot only the Ears but also the Head of the Hippopotamus\u201d"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8569-1183","authenticated-orcid":false,"given":"Mady","family":"Ou\u00e9draogo","sequence":"first","affiliation":[{"name":"Centre de Recherche en Epid\u00e9miologie, Biostatistiques et Recherche Clinique, Ecole de Sant\u00e9 Publique, Universit\u00e9 Libre de Bruxelles, 1070 Brussels, Belgium"},{"name":"Institut de Recherche Sant\u00e9 et Soci\u00e9t\u00e9s, Facult\u00e9 de Sant\u00e9 Publique, Universit\u00e9 catholique de Louvain, 1200 Brussels, Belgium"},{"name":"Institut National de la Statistique et de la D\u00e9mographie (INSD), Ouagadougou 01 BP 374, Burkina Faso"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toussaint","family":"Rouamba","sequence":"additional","affiliation":[{"name":"Centre de Recherche en Epid\u00e9miologie, Biostatistiques et Recherche Clinique, Ecole de Sant\u00e9 Publique, Universit\u00e9 Libre de Bruxelles, 1070 Brussels, Belgium"},{"name":"Unit\u00e9 de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Sant\u00e9, Centre National de la Recherche Scientifique et Technologique, Ouagadougou 11 BP 218, Burkina Faso"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00e9kou","family":"Samadoulougou","sequence":"additional","affiliation":[{"name":"Evaluation Platform on Obesity Prevention, Quebec Heart and Lung Institute, Quebec, QC G1V 4G5, Canada"},{"name":"Centre for Research on Planning and Development (CRAD), Universit\u00e9 Laval, Quebec, QC G1V 0A6, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fati","family":"Kirakoya-Samadoulougou","sequence":"additional","affiliation":[{"name":"Centre de Recherche en Epid\u00e9miologie, Biostatistiques et Recherche Clinique, Ecole de Sant\u00e9 Publique, Universit\u00e9 Libre de Bruxelles, 1070 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,1,8]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2018). 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