Abstract
BackgroundIn areas of declining malaria transmission such as in The Gambia, the identification of malaria infected individuals becomes increasingly harder. School surveys may be used to identify foci of malaria transmission in the community.MethodsThe survey was carried out in May–June 2011, before the beginning of the malaria transmission season. Thirty two schools in the Upper River Region of The Gambia were selected with probability proportional to size; in each school approximately 100 children were randomly chosen for inclusion in the study. Each child had a finger prick blood sample collected for the determination of antimalarial antibodies by ELISA, malaria infection by microscopy and PCR, and for haemoglobin measurement. In addition, a simple questionnaire on socio-demographic variables and the use of insecticide-treated bed nets was completed. The cut-off for positivity for antimalarial antibodies was obtained using finite mixture models. The clustered nature of the data was taken into account in the analyses.ResultsA total of 3,277 children were included in the survey. The mean age was 10 years (SD = 2.7) [range 4–21], with males and females evenly distributed. The prevalence of malaria infection as determined by PCR was 13.6% (426/3124) [95% CI = 12.2–16.3] with marked variation between schools (range 3–25%, p<0.001), while the seroprevalence was 7.8% (234/2994) [95%CI = 6.4–9.8] for MSP119, 11.6% (364/2997) [95%CI = 9.4–14.5] for MSP2, and 20.0% (593/2973) [95% CI = 16.5–23.2) for AMA1. The prevalence of all the three antimalarial antibodies positive was 2.7% (79/2920).ConclusionsThis survey shows that malaria prevalence and seroprevalence before the transmission season were highly heterogeneous.
Highlights
In areas of declining malaria transmission such as in The Gambia, the identification of malaria infected individuals becomes increasingly harder
Among the 77 primary schools in Upper River Region (URR) attended by 16,554 children, 32 were selected and from these 3,277 children were enrolled into the survey
PCR analysis was carried out on 3,124 filter paper blood samples; 426 (13.6%) [95% CI = 12.2–16.3] were found to be positive for malaria infection, though only 278 (8.9%) were confirmed to be Plasmodium falciparum while for the remaining samples no other Plasmodium species was found
Summary
In areas of declining malaria transmission such as in The Gambia, the identification of malaria infected individuals becomes increasingly harder. Monitoring can be done using routine surveillance data from health facilities and household surveys, the latter providing information on indicators such as coverage of vector control methods (long lasting insecticide treated nets and indoor residual spraying), malaria transmission or malaria mortality [2]. E.g. The Democratic Republic of Congo [9] and Ethiopia [16], school surveys provided information on the malaria geographical heterogeneity and helped identifying clusters of transmission. Their representativeness, as compared to the whole community, will obviously depend on the degree of school attendance
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