Abstract
BackgroundAs the geographical distribution of malaria transmission becomes progressively clustered, identifying residual pockets of transmission is important for research and for targeting interventions. Malarial antibody-based surveillance is increasingly recognised as a valuable complement to classic methods for the detection of infection foci especially at low transmission levels. The study presents serological evidence for transmission heterogeneity among school children in The Gambia measured during the dry, non-transmission season.MethodsHealthy primary school children were randomly selected from 30 schools across the country and screened for malaria infection (microscopy) and antimalarial antibodies (MSP119). Antibody distribution was modelled using 2-component finite mixture model with cut-off for positivity from pooled sera set at 2-standard deviation from the mean of the first component. Factors associated with a positive serological status were identified in a univariate model and then combined in a multilevel mixed-effects logistic regression model, simultaneously adjusting for variations between individuals and school.ResultsA total of 4140 children, 1897 (46%) boys, were enrolled with mean age of 10.2 years (SD 2.6, range 4–20 years). Microscopy results available for 3640 (87.9%) children showed that 1.9% (69) were positive for Plasmodium falciparum infections, most of them (97.1%, 67/69) asymptomatic. The overall seroprevalence was 12.7% (527/4140) with values for the schools ranging from 0.6% to 43.8%. Age (OR 1.12, 95% CI 1.07–1.16,) and parasite carriage (OR 3.36, 95% CI 1.95–5.79) were strongly associated with seropositivity.ConclusionSerological responses to malaria parasites could identify individuals who were or had been infected, and clusters of residual transmission. Field-adapted antibody tests able to guide mass screening and treatment campaigns would be extremely useful.
Highlights
In the past decade, there has been a significant but uneven reduction in malaria indicators [1,2] following the scale up of effective interventions, partly attributed to underlying heterogeneities in malaria transmission [3]
Malaria endemicity and transmission are described by the parasite prevalence and the entomological inoculation rate (EIR) respectively, and these methods remain useful in many settings
In low transmission settings, the paucity of infected mosquitoes, the need to collect and analyse large number of samples coupled with declining sensitivities of microscopy, RDTs and EIRs reduce the efficiency of these methods [5]
Summary
There has been a significant but uneven reduction in malaria indicators [1,2] following the scale up of effective interventions, partly attributed to underlying heterogeneities in malaria transmission [3]. An important first step is to determine the tools and methods that can efficiently detect these variations in malaria transmission [4]. Malaria endemicity and transmission are described by the parasite prevalence and the entomological inoculation rate (EIR) respectively, and these methods remain useful in many settings. Estimating the prevalence of antimalarial antibody (seroprevalence) is increasingly recognised as a valuable complement to classic methods for defining transmission intensity [6,7], determining heterogeneity in outcomes of malaria interventions [8] and for malaria surveillance [9]. Malarial antibody-based surveillance is increasingly recognised as a valuable complement to classic methods for the detection of infection foci especially at low transmission levels. The study presents serological evidence for transmission heterogeneity among school children in The Gambia measured during the dry, non-transmission season
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