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. 2019 Nov 21;18(1):370.
doi: 10.1186/s12936-019-2999-0.

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

Nina C Brunner  1   2 , Frank Chacky  3   4 , Renata Mandike  3   4 , Ally Mohamed  3   4 , Manuela Runge  1   2 , Sumaiyya G Thawer  1   2   3 , Amanda Ross  1   2 , Penelope Vounatsou  1   2 , Christian Lengeler  1   2 , Fabrizio Molteni  1   2   3 , Manuel W Hetzel  5   6
Affiliations

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

Nina C Brunner et al. Malar J. .

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.

Keywords: Malaria; Malaria elimination; Pregnant women; Surveillance.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
District test-positivity difference SMPS − ANC against ANC malaria test-positivity with regression line and 95% limits of agreement, normalized for ITN use in school children. a Districts with seasonal malaria transmission, by district type. b Districts with perennial malaria transmission, by district type
Fig. 2
Fig. 2
Regional test-positivity difference MIS − ANC against ANC malaria test-positivity with regression line and 95% limits of agreement
Fig. 3
Fig. 3
District test-positivity difference MAP − ANC against ANC malaria test-positivity with regression line and 95% limits of agreement
Fig. 4
Fig. 4
District test-positivity difference BGM − ANC against ANC malaria test-positivity with regression line and 95% limits of agreement. a Districts with seasonal malaria transmission, by district type. b Districts with perennial malaria transmission, by district type
See this image and copyright information in PMC

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