The potential of pregnant women as a sentinel population for malaria surveillance

Abstract Background 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. However, the representa...

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Bibliographic Details
Published in:Malaria Journal
Main Authors: Nina C. Brunner, Frank Chacky, Renata Mandike, Ally Mohamed, Manuela Runge, Sumaiyya G. Thawer, Amanda Ross, Penelope Vounatsou, Christian Lengeler, Fabrizio Molteni, Manuel W. Hetzel
Format: Article in Journal/Newspaper
Language:English
Published: BMC 2019
Subjects:
Malaria
Surveillance
Malaria elimination
Pregnant women
Arctic medicine. Tropical medicine
RC955-962
Infectious and parasitic diseases
RC109-216
Arctic
Online Access:https://doi.org/10.1186/s12936-019-2999-0
https://doaj.org/article/855db0fa1555491f9f29cf57723308ac
Description
Summary:Abstract Background 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. However, the representativeness of routine ANC malaria test-positivity and its relationship with prevalence in other population subgroups are yet to be investigated. Methods Monthly 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. Results The 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. Conclusions Pregnant 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.

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