The use of schools for malaria surveillance and programme evaluation in Africa

Abstract

Effective malaria control requires information on both the geographical distribution of malaria risk and the effectiveness of malaria interventions. The current standard for estimating malaria infection and impact indicators are household cluster surveys, but their complexity and expense preclude frequent and decentralized monitoring. This paper reviews the historical experience and current rationale for the use of schools and school children as a complementary, inexpensive framework for planning, monitoring and evaluating malaria control in Africa. Consideration is given to (i) the selection of schools; (ii) diagnosis of infection in schools; (iii) the representativeness of schools as a proxy of the communities they serve; and (iv) the increasing need to evaluate interventions delivered through schools. Finally, areas requiring further investigation are highlighted.

Elevated prevalence of malnutrition and malaria among school-aged children and adolescents in war-ravaged South Sudan

“…School-based malaria screening, in use for over a century, is an inexpensive framework for malaria surveillance that can complement community-based surveys. 18 For example, large-scale school parasite surveys documented the decline of malaria in the USA during the 1920-1940s, and continue to be used by the Ministries of Health of modern African states to monitor the impact of malaria control efforts. 18 The representativeness of a school survey for the community at large depends on the catchment area and may be influenced by gender, wealth and health differentials in school enrolment.…”

“…18 For example, large-scale school parasite surveys documented the decline of malaria in the USA during the 1920-1940s, and continue to be used by the Ministries of Health of modern African states to monitor the impact of malaria control efforts. 18 The representativeness of a school survey for the community at large depends on the catchment area and may be influenced by gender, wealth and health differentials in school enrolment. 23 Unfortunately the school enrolment for South Sudan may be very low as children and youth are not able to attend school in the aftermath of war that decimated the education infrastructure.…”

“…Underrepresentation of female students in our cohort may reflect a predilection for education of males. 18 Thus, high malaria prevalence in the school likely implies high transmission in the community of Akuak Rak, although the degree to which the community prevalence may be over-or underestimated is difficult to quantify.…”

“…26 Finally, infected school children may act as a reservoir for onward transmission of malaria to others in the community, and treatment may block parasite spread. 18 This may be an operationally efficient mechanism to target a high-prevalence group for malaria control. 18 On the other hand, a recent trial in Burkina Faso indicated no impact of IST on community-wide malaria transmission.…”

“…Recent experience in 65 schools in Kenya showed that this RDT had a sensitivity of 99% and a specificity of 85% compared to light microscopic examination of Giemsa-stained peripheral blood films. 18 Children found to be RDT-positive were treated with a six dose regimen of artemisinin combination therapy (ACT) according to WHO guidelines, 19 irrespective of symptoms.…”