5.6-Malaria 219. In Togo, malaria is the first cause of morbidity and hospital morbidity with a high vulnerability of children of less than 5 years. It is endemic with a transmission which lasts almost throughout the year all over the country. On the average, it accounted for 46% of the rate of morbidity in 2013, whereas it was 42% in 2008. The hospital mortality reduced from 20% in 2008 to 12.26% in 2013 with an average fatality of 3%10. The prevalence of malaria among children between 6-59 months is 36 %; the rate is between 15 % in the urban areas and 47 % in the rural communities.11 220. In the area of malaria prevention, the low rate of use of long-lasting insecticidal nets (LLINs) must be pointed, 33.5% in general and 42.7% by children under 5 years of age according to (EDSTIII 2013-2014), whereas the target was 85%. This low use is related to the behaviour of the population and local communication gaps. Mesures are envisaged to improve the local communication aspect and bring about change in behaviours. 221. With regard to intermittent preventive treatment, 168,841 pregnant women in 2014 were provided with services as against 145.019 in 2013. This improvement is due to the training of service providers in 2013 and the improvement in the availability of inputs in 2014. 222. In view of the new treatment policy for malaria, the artemisinin-based combination therapy (ACT) is used in treating simple malaria to the detriment of chloroquine which has become ineffective. Meanwhile, the sulfadoxinepyrimethamine combination is used for intermittent preventive treatment to prevent malaria during pregnancy. 223. The main interventions carried out in combating malaria in 2014 are: the intensification of social mobilisation with free services being provided for simple malaria, intermittent preventive treatment (IPTp) among pregnant women, chemoprevention of seasonal malaria (CPS) in the case of children under 5 years of age in the Tône, Kpendjal, Tandjoaré and Cinkassé districts) of the Savannah Region, mass distribution campaign of long-lasting Insecticide Treatment Mosquito Nets (LLINs). 10 11 Major Health Indicators of Togo, DISER 2013 EDSTIII (2013-2014) 68

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