Abstract
BackgroundWith increasing spatial heterogeneity of malaria transmission and a shift of the disease burden towards older children and adults, pregnant women attending antenatal care (ANC) have been proposed as a pragmatic sentinel population for malaria surveillance. However, the representativeness of routine ANC malaria test-positivity and its relationship with prevalence in other population subgroups are yet to be investigated.MethodsMonthly ANC malaria test-positivity data from all Tanzanian health facilities for January 2014 to May 2016 was compared to prevalence data from the School Malaria Parasitaemia Survey 2015, the Malaria Indicator Survey (MIS) 2015/16, the Malaria Atlas Project 2015, and a Bayesian model fitted to MIS data. Linear regression was used to describe the difference between malaria test-positivity in pregnant women and respective comparison groups as a function of ANC test-positivity and potential covariates.ResultsThe relationship between ANC test-positivity and survey prevalence in children follows spatially and biologically meaningful patterns. However, the uncertainty of the relationship was substantial, particularly in areas with high or perennial transmission. In comparison, modelled data estimated higher prevalence in children at low transmission intensities and lower prevalence at higher transmission intensities.ConclusionsPregnant women attending ANC are a pragmatic sentinel population to assess heterogeneity and trends in malaria prevalence in Tanzania. Yet, since ANC malaria test-positivity cannot be used to directly predict the prevalence in other population subgroups, complementary community-level measurements remain highly relevant.
Highlights
With increasing spatial heterogeneity of malaria transmission and a shift of the disease burden towards older children and adults, pregnant women attending antenatal care (ANC) have been proposed as a pragmatic sentinel population for malaria surveillance
Van Eijk et al showed that the malaria prevalence in primigravidae women compared to the prevalence in children provides results with less heterogeneity; gravidity might have to be taken into account when using pregnant women attending ANC as a sentinel population for malaria surveillance [7]
This study shows that the relationship between routine ANC malaria test-positivity data and survey prevalence data in children follows expected patterns
Summary
With increasing spatial heterogeneity of malaria transmission and a shift of the disease burden towards older children and adults, pregnant women attending antenatal care (ANC) have been proposed as a pragmatic sentinel population for malaria surveillance. The representativeness of routine ANC malaria test-positivity and its relationship with prevalence in other population subgroups are yet to be investigated. The relationship between the malaria prevalence in pregnant women and children aged 0–59 months has previously been investigated in a systematic review and meta-analysis which found a strong correlation between both groups [7]. The authors made a pooled analysis of prevalence data obtained from different administrative levels which made it impossible to give any recommendations on what spatial scale ANC prevalence might be used to monitor malaria transmission. Another study by Hellewell et al found that clinical malaria incidence in children can predict ANC prevalence up to 3 months in the future but not vice versa [8]. The validity of large-scale routine ANC prevalence data for monitoring transmission in children has yet to be investigated
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
