Abstract
ObjectiveTo design and implement surveys of malaria infection and coverage of malaria control interventions among school children in Kenya in order to contribute towards a nationwide assessment of malaria.MethodsThe country was stratified into distinct malaria transmission zones based on a malaria risk map and 480 schools were visited between October 2008 and March 2010. Surveys were conducted in two phases: an initial opportunistic phase whereby schools were selected for other research purposes; and a second phase whereby schools were purposively selected to provide adequate spatial representation across the country. Consent for participation was based on passive, opt-out consent rather than written, opt-in consent because of the routine, low-risk nature of the survey. All children were diagnosed for Plasmodium infection using rapid diagnostic tests, assessed for anaemia and were interviewed about mosquito net usage, recent history of illness, and socio-economic and household indicators. Children's responses were entered electronically in the school and data transmitted nightly to Nairobi using a mobile phone modem connection. RDT positive results were corrected by microscopy and all results were adjusted for clustering using random effect regression modelling.Results49,975 children in 480 schools were sampled, at an estimated cost of US$ 1,116 per school. The overall prevalence of malaria and anaemia was 4.3% and 14.1%, respectively, and 19.0% of children reported using an insecticide-treated net (ITN). The prevalence of infection showed marked variation across the country, with prevalence being highest in Western and Nyanza provinces, and lowest in Central, North Eastern and Eastern provinces. Nationally, 2.3% of schools had reported ITN use >60%, and low reported ITN use was a particular problem in Western and Nyanza provinces. Few schools reported having malaria health education materials or ongoing malaria control activities.ConclusionSchool malaria surveys provide a rapid, cheap and sustainable approach to malaria surveillance which can complement household surveys, and in Kenya, show that large areas of the country do not merit any direct school-based control, but school-based interventions, coupled with strengthened community-based strategies, are warranted in western and coastal Kenya. The results also provide detailed baseline data to inform evaluation of school-based malaria control in Kenya.
Highlights
The epidemiology of malaria in sub-Saharan Africa (SSA) is in transition, with funding agencies dedicating substantial resources in tackling malaria and national governments making great efforts in increasing access to malaria control interventions
Malaria monitoring and evaluation of interventions in malaria endemic countries in SSA has been mainly based on periodic national household surveys, including malaria indicator survey [9] as well as malaria modules of demographic health surveys [10] and multiple indicator cluster surveys [11], where young children and pregnant women form the sample population
The principal advantages of such household surveys are that they adequately capture the underlying variation in the sampled population and the flexibility of data collection instruments which can accommodate a number of questions on a variety of topics
Summary
The epidemiology of malaria in sub-Saharan Africa (SSA) is in transition, with funding agencies dedicating substantial resources in tackling malaria and national governments making great efforts in increasing access to malaria control interventions. It is essential that this estimates of PR form the best evidence base for planning, implementing and evaluating control, with PR among children aged two to 10 years providing a standard measure of PR [8]. Malaria monitoring and evaluation of interventions in malaria endemic countries in SSA has been mainly based on periodic national household surveys, including malaria indicator survey [9] as well as malaria modules of demographic health surveys [10] and multiple indicator cluster surveys [11], where young children and pregnant women form the sample population. The principal advantages of such household surveys are that they adequately capture the underlying variation in the sampled population and the flexibility of data collection instruments which can accommodate a number of questions on a variety of topics. A cheaper and rapid complementary approach to household surveys would be to use the existing school system for schoolbased malariometric surveys [12]
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