Abstract
BackgroundSchool surveys provide an operational approach to assess malaria transmission through parasite prevalence. There is limited evidence on the comparability of prevalence estimates obtained from school and community surveys carried out at the same locality.MethodsConcurrent school and community cross-sectional surveys were conducted in 46 school/community clusters in the western Kenyan highlands and households of school children were geolocated. Malaria was assessed by rapid diagnostic test (RDT) and combined seroprevalence of antibodies to bloodstage Plasmodium falciparum antigens.ResultsRDT prevalence in school and community populations was 25.7% (95% CI: 24.4-26.8) and 15.5% (95% CI: 14.4-16.7), respectively. Seroprevalence in the school and community populations was 51.9% (95% CI: 50.5-53.3) and 51.5% (95% CI: 49.5-52.9), respectively. RDT prevalence in schools could differentiate between low (<7%, 95% CI: 0-19%) and high (>39%, 95% CI: 25-49%) transmission areas in the community and, after a simple adjustment, were concordant with the community estimates.ConclusionsEstimates of malaria prevalence from school surveys were consistently higher than those from community surveys and were strongly correlated. School-based estimates can be used as a reliable indicator of malaria transmission intensity in the wider community and may provide a basis for identifying priority areas for malaria control.
Highlights
Obtaining accurate estimates of malaria transmission can be an intensive process, especially when transmission is low [1]
Due to the random sampling, 4.4% of children were sampled at school and had their compound visited by a field team during the community survey
The data show that school surveys exhibit good correlation with the community measures of infection and exposure
Summary
Obtaining accurate estimates of malaria transmission can be an intensive process, especially when transmission is low [1]. The school-aged population has been shown to carry higher parasite prevalence and densities compared to adults [8,9] and tend to have a lower reported rate of bednet use [10]. The lower net use combined with the higher parasite densities suggest that school-aged children experience a high malaria burden and may be important sources for onward transmission of parasites [11]. School surveys provide an operational approach to assess malaria transmission through parasite prevalence. There is limited evidence on the comparability of prevalence estimates obtained from school and community surveys carried out at the same locality. School-based estimates can be used as a reliable indicator of malaria transmission intensity in the wider community and may provide a basis for identifying priority areas for malaria control
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