Using antenatal care as a platform for malaria surveillance data collection: study protocol

Abstract

Background While many malaria-endemic countries have health management information systems that can measure and report malaria trends in a timely manner, these routine systems have limitations. Periodic community cross-sectional household surveys are used to estimate malaria prevalence and intervention coverage but lack geographic granularity and are resource intensive. Incorporating malaria testing for all women at their first antenatal care (ANC) visit (i.e., ANC1) could provide a more timely and granular source of data for monitoring trends in malaria burden and intervention coverage. This article describes a protocol designed to assess if ANC-based surveillance could be a pragmatic tool to monitor malaria. Methods This is an observational, cross-sectional study conducted in Benin, Burkina Faso, Mozambique, Nigeria, Tanzania, and Zambia. Pregnant women attending ANC1 in selected health facilities will be tested for malaria infection by rapid diagnostic test and administered a brief questionnaire to capture key indicators of malaria control intervention coverage and care-seeking behaviour. In each location, contemporaneous cross-sectional household surveys will be leveraged to assess correlations between estimates obtained using each method, and the use of ANC data as a tool to track trends in malaria burden and intervention coverage will be validated. Results This study will assess malaria prevalence at ANC1 aggregated at health facility and district levels, and by gravidity relative to current pregnancy (i.e., gravida 1, gravida 2, and gravida 3 +). ANC1 malaria prevalence will be presented as monthly trends. Additionally, correlation between ANC1 and household survey–derived estimates of malaria prevalence, bed net ownership and use, and care-seeking will be assessed. Conclusion ANC1-based surveillance has the potential to provide a cost-effective, localized measure of malaria prevalence that is representative of the general population and useful for tracking monthly changes in parasite prevalence, as well as providing population-representative estimates of intervention coverage and care-seeking behavior. This study will evaluate the representativeness of these measures and collect information on operational feasibility, usefulness for programmatic decision-making, and potential for scale-up of malaria ANC1 surveillance.

Trends in SARS-CoV-2 seroprevalence among pregnant women attending first antenatal care visits in Zambia: A repeated cross-sectional survey, 2021–2022

“…In Zambia, 97% of women attend at least one ANC visit during pregnancy, and antenatal attendees have long served as a sentinel population for HIV, syphilis, and malaria surveillance [15][16][17]. Whether this platform can be leveraged to monitor COVID-19 has yet to be determined.…”

Malaria species prevalence among asymptomatic individuals in four regions of Mainland Tanzania

“…The random subset was representative of the regional sample distribution (X 2 (3,2) = 2.43, p (2 df) = 0.3, Table S1), but not representative of the age group distribution (X 2 (3,2) = 10.46, p (2 df) = 0.005, Table S2), or the sex distribution (X 2 (2,2) = 43.65, p (1 df) < 0.001, Table S3). An additional 734 samples were drawn from 3,213 collected from children under five during cross-sectional household surveys for the group antenatal care project (GANC) [14,15] in Geita in 2021.…”