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

Brunner, Nina C.; Chacky, Frank; Mandike, Renata; Amara, Mohamed; Runge, Manuela; Thawer, Sumaiyya G.; Ross, Amanda; Vounatsou, Penelope; Lengeler, Christian; Molteni, Fabrizio; Hetzel, Manuel W

doi:10.1186/s12936-019-2999-0

Cited by 15 publications

(19 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It has been debated whether pregnant women should be considered as a sentinel population for malaria surveillance [17,51]. The current study found that the geographical pattern of malaria in pregnancy was similar to malaria in overall population, suggesting that screening of pregnant women can help in identifying areas having high burden of malaria, including asymptomatic malaria.…”

Section: Discussionmentioning

confidence: 60%

Malaria prevalence in symptomatic and asymptomatic pregnant women in a high malaria-burden state in India

2020

View full text Add to dashboard Cite

Introduction: Malaria in pregnancy ('MiP') poses risks to mother, foetus and newborn. Studies from Africa and Asia have reported high prevalence of 'MiP' and recommended further research to address 'MiP'. India has a significant burden of 'MiP' but most of the studies are a decade old. Hardly any studies exist in India that report on asymptomatic malaria in pregnant women. The current Indian policies for malaria control are silent on 'MiP'. A campaign was carried out by community health workers (CHWs) in 2019 to screen pregnant women across rural Chhattisgarh. Methods: This is a cross-sectional study. Malaria was tested in pregnant women by CHWs using bivalent rapid tests. Multi-stage sampling was used to cover 21,572 pregnant women screened across different geographical areas of rural Chhattisgarh. Cross-tabulation and multivariate regression were used to find out the relationship of 'MiP' with different symptoms and geographical areas. GIS maps were used to compare malaria in pregnant women against overall febrile population. Results: In rural Chhattisgarh, malaria was present in 0.81% of the pregnant women at the time of testing. 'MiP' prevalence varied across geographies, reaching 4.48% in the geographical division with highest burden. Febrile pregnant women had three times greater malaria-positivity than overall febrile population and both showed a similar geographical pattern. Discussion: Prevalence of 'MiP' was found to be less than earlier studies in the state. Though overall malaria in India has shown some decline, a policy response is needed for 'MiP' in high-burden areas. Fever, diarrhoea and jaundice remain relevant symptoms in 'MiP', but around one fourth of malaria-positive pregnant-women were afebrile, suggesting the need for strategies to address it. Conclusion: The current study based on a large sample provides fresh evidence on 'MiP' in India. It used CHWs as skilled providers for large-scale screening for malaria. In high-burden areas, intermittent screening and treatment (IST) of all pregnant women can be a useful strategy in order to address 'MiP'. Pregnant women can be considered as a pertinent sentinel population for malaria. The global and national policies need to evolve concrete strategies for addressing malaria in pregnancy.

show abstract

Section: Discussionmentioning

confidence: 60%

Malaria prevalence in symptomatic and asymptomatic pregnant women in a high malaria-burden state in India

2020

View full text Add to dashboard Cite

show abstract

“…Malaria testing by RDT among pregnant women attending their first visit at ANC clinics was implemented in mainland Tanzania in mid-2013 and integrated into the routine HMIS [25][26][27]. Tanzania is the only country in Africa to have implemented routine ANC malaria testing for surveillance.…”

Section: Test Positivity Rate From Antenatal Care Clinics (Anc)mentioning

confidence: 99%

Sub-national stratification of malaria risk in mainland Tanzania: a simplified assembly of survey and routine data

Thawer

Chacky

Runge

et al. 2020

Malar J

Self Cite

109

View full text Add to dashboard Cite

Background: Recent malaria control efforts in mainland Tanzania have led to progressive changes in the prevalence of malaria infection in children, from 18.1% (2008) to 7.3% (2017). As the landscape of malaria transmission changes, a sub-national stratification becomes crucial for optimized cost-effective implementation of interventions. This paper describes the processes, data and outputs of the approach used to produce a simplified, pragmatic malaria risk stratification of 184 councils in mainland Tanzania. Methods: Assemblies of annual parasite incidence and fever test positivity rate for the period 2016-2017 as well as confirmed malaria incidence and malaria positivity in pregnant women for the period 2015-2017 were obtained from routine district health information software. In addition, parasite prevalence in school children (PfPR 5to16) were obtained from the two latest biennial council representative school malaria parasitaemia surveys, 2014-2015 and 2017. The PfPR 5to16 served as a guide to set appropriate cutoffs for the other indicators. For each indicator, the maximum value from the past 3 years was used to allocate councils to one of four risk groups: very low (< 1%PfPR 5to16), low (1− < 5%PfPR 5to16), moderate (5− < 30%PfPR 5to16) and high (≥ 30%PfPR 5to16). Scores were assigned to each risk group per indicator per council and the total score was used to determine the overall risk strata of all councils. Results: Out of 184 councils, 28 were in the very low stratum (12% of the population), 34 in the low stratum (28% of population), 49 in the moderate stratum (23% of population) and 73 in the high stratum (37% of population). Geographically, most of the councils in the low and very low strata were situated in the central corridor running from the northeast to southwest parts of the country, whilst the areas in the moderate to high strata were situated in the northwest and southeast regions. Conclusion: A stratification approach based on multiple routine and survey malaria information was developed. This pragmatic approach can be rapidly reproduced without the use of sophisticated statistical methods, hence, lies within the scope of national malaria programmes across Africa.

show abstract

“…In these countries, whilst more than 80% of pregnant women would make at least one ANC visit, their adherence to subsequent visits for the recommended IPTp 3+ policy ( WHO, 2014 ) remains poor ( WHO, 2015 ), with only 24% making their first ANC visit during the first trimester ( Mgata and Maluka, 2019 ; Chimatiro et al, 2018 ). Several studies have suggested pregnant women attending their first ANC could provide data as proxy for malaria transmission or as sentinel population for malaria surveillance ( van Eijk et al, 2015 ; Kitojo et al, 2019 ; Brunner et al, 2019 ). However, the same studies reports some shortfalls in using ANC data such as variation in sensitivity at different endemicities, suggesting ANC data was particularly useful for monitoring in areas approaching elimination ( Kitojo et al, 2019 ).…”

Section: Discussionmentioning

confidence: 99%

“…However, the same studies reports some shortfalls in using ANC data such as variation in sensitivity at different endemicities, suggesting ANC data was particularly useful for monitoring in areas approaching elimination ( Kitojo et al, 2019 ). Moreover, ANC malaria test-positivity cannot be used to directly predict the prevalence in other population subgroups, where complementary community-level measurements remain highly relevant ( Brunner et al, 2019 ). Other limitations are typically associated with routine data, such as imperfect reporting and difficult to quantify errors in data collection, transcription, entry, and collation at all levels ( Kitojo et al, 2019 ).…”

Section: Discussionmentioning

confidence: 99%

“…Likewise, given the dynamics on malaria infection and immunity ( Langhorne et al, 2008 ), pregnant women being adults are likely to have a stronger acquired immunity to malaria, and that malarial parasites are likely to sequester in the placenta rendering it difficult to detect on peripheral smear ( van Eijk et al, 2015 ; Cowman et al, 2016 ).Therefore, as noted elsewhere, ANC malaria test-positivity cannot be used to directly predict the prevalence in other population subgroups, prompting the need of complementary community-level measurements ( Brunner et al, 2019 ). School-aged children are immunologically in transition i.e.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Prevalence of malaria parasitaemia in school-aged children and pregnant women in endemic settings of sub-Saharan Africa: A systematic review and meta-analysis

Makenga

Menon

Baraka

et al. 2020

Parasite Epidemiology and Control

View full text Add to dashboard Cite

Despite increased malaria control efforts, school-aged children (5–14 years) have higher a malaria prevalence compared to children under-five. In high-transmission settings, up to 70% of school-aged children harbour malaria parasitaemia and therefore contribute significantly to the reservoir for transmission. A systematic review was performed to explore the correlation between the malaria parasite carriage in pregnant women and school-aged children living in similar endemic settings of sub Saharan Africa to inform strategies to improve targeted malaria control. In order to obtain data on malaria prevalence in pregnant women and school-aged children living in the same endemic setting, we searched the Malaria in Pregnancy Library, PubMed, Cochrane library and Web of Science in December 2018. We fit a fixed effect model to obtain a pooled risk ratio (PRR) of malaria in school-aged children versus pregnant women and used Poisson regression to estimate risk ratios in school-aged children for every increase in prevalence in pregnant women. We used data from six (out of 1096) sources that included 10 data points. There was a strong linear relation between the prevalence of malaria infection in pregnant women and school-aged children ( r = 0·93, p < 0·0001). School-aged children were nearly twice at risk to carry parasites compared to pregnant women (RR = 1.95, 95% CI: 1·69–2.25, p < 0.01). Poisson regression showed that a 1% increase in prevalence of malaria infection in pregnant women was significantly associated with increase in risk in school-aged children by 4%. Malaria infection prevalence in school-aged children is strongly correlated with the prevalence in pregnant women living in the same community, and may be considered as alternative indicators to track temporal and spatial trends in malaria transmission intensity. Chemoprevention strategies targeting school-aged children should be explored to reduce malaria burden and transmission in school-aged children and its potential impact on communities.

show abstract

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

Cited by 15 publications

References 29 publications

Malaria prevalence in symptomatic and asymptomatic pregnant women in a high malaria-burden state in India

Malaria prevalence in symptomatic and asymptomatic pregnant women in a high malaria-burden state in India

Sub-national stratification of malaria risk in mainland Tanzania: a simplified assembly of survey and routine data

Prevalence of malaria parasitaemia in school-aged children and pregnant women in endemic settings of sub-Saharan Africa: A systematic review and meta-analysis

Contact Info

Product

Resources

About