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Sub-national stratification of malaria risk in mainland Tanzania: a simplified assembly of survey and routine data
Abstract
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 (Pf PR 5to16) were obtained from the two latest biennial council representative school malaria parasitaemia surveys, 2014–2015 and 2017. The Pf PR 5to16 served as a guide to set appropriate cut-offs 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%Pf PR 5to16), low (1− < 5%Pf PR 5to16), moderate (5− < 30%Pf PR 5to16) and high (≥ 30%Pf PR 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 north-east to south-west parts of the country, whilst the areas in the moderate to high strata were situated in the north-west and south-east 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.
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As noted in previous studies, alignment with other sources of information and stakeholder expectations were considered important for stakeholders to have trust in the maps.
“As noted in previous studies [22, 46, 48], the alignment with other sources of information and stakeholder expectations were considered important for stakeholders to have trust in the maps.”
From How useful are malaria risk maps at the country level? Perceptions of decision-makers in Kenya, Malawi and the Democratic Republic of Congo (2020) · cites this paper as [46]
The desire for granular and timely maps along with the increasing availability and quality of malaria routine data drove some countries towards the use of routine data in the stratification of malaria, either using Test Positivity Rate or case incidence.
“The desire for granular and timely maps along with the increasing availability and quality of malaria routine data drove some countries towards the use of routine data in the stratification of malaria, either using Test Positivity Rate or case incidence [46, 47].”
From How useful are malaria risk maps at the country level? Perceptions of decision-makers in Kenya, Malawi and the Democratic Republic of Congo (2020) · cites this paper as [46]
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van Eijk, A. M., Hill, J., Noor, A. M., Snow, R. W., & ter Kuile, F. O. (2015) · The Lancet Global Health · doi:10.1016/s2214-109x(15)00049-2 · Cited by 130
Self-citationA Robust Estimator of Malaria Incidence from Routine Health Facility Data
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Ghilardi, L., Okello, G., Nyondo-Mipando, L., Chirambo, C. M., Malongo, F., Hoyt, J., Lee, J., Sedekia, Y., Parkhurst, J., Lines, J., et al. (2020) · Malaria Journal · doi:10.1186/s12936-020-03425-z · Cited by 16
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Metadata
- Authors
- Thawer, S. G., Chacky, F., Runge, M., Reaves, E., Mandike, R., Lazaro, S., Mkude, S., Rumisha, S. F., Kumalija, C., Lengeler, C., Mohamed, A., Pothin, E., Snow, R. W., & Molteni, F.
- Venue
- Malaria Journal
- Published
- 2020-05-08
- Volume
- 19
- Issue
- 1
- ISSN
- 1475-2875
- PMC
- PMC7206674
- Cited by
- 100
- References
- 2
- Language
- en
- Funders
- NETCELL Project - Swiss TPH, Swiss Agency for Development and Cooperation (-)
- Global Fund to Fight Aids, Tuberculosis and Malaria (GFATM) and the Swiss Tropical and Public Health Institute (-)
- Wellcome Trust (103602, 212176)
- Department for International Development (203155)
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