How useful are malaria risk maps at the country level? Perceptions of decision-makers in Kenya, Malawi and the Democratic Republic of Congo

Probably not a substantial claim. It may state two separate claims as one.

Modelled PfPR maps are developed by assembling community-based PfPR data from the general population or specific population surveys and used within geostatistical models to provide estimates of infection prevalence at unsampled locations.

“Modelled PfPR maps are developed by assembling community-based malaria parasite prevalence (PfPR) data from the general population or specific population surveys, such as school based children [12–16], and used within geostatistical models to provide estimates of infection prevalence at unsampled locations [17].”

• cites [12] Gitonga CW, Karanja PN, Kihara J, Mwanje M, et al. Implementing school malaria surveys in Kenya: towards a national surveillance system. Malar J. 2010;9:306. sourceSupported
• cites [13] Swana EK, Yav TI, Ngwej LM, Mupemba BN, Suprianto, Mukeng CK, et al. School-based malaria prevalence: informative systematic surveillance measure to assess epidemiological impact of malaria control interventions in the Democratic Republic of the Congo. Malar J. 2018;17:141. sourceSupported
• cites [14] Okebe J, Affara M, Correa S, Muhammad AK, Nwakanma D, Drakeley C, et al. School-based countrywide seroprevalence survey reveals spatial heterogeneity in malaria transmission in the Gambia. PLoS ONE. 2014;9:e110926. sourceSupported
• cites [15] Houngbedji CA, Chammartin F, Yapi RB, Hürlimann E, N’Dri PB, Silué KD, et al. Spatial mapping and prediction of Plasmodium falciparum infection risk among school-aged children in Côte d’Ivoire. Parasit Vectors. 2016;9:494. sourceSupported
• cites [16] Chacky F, Runge M, Rumisha SF, MacHafuko P, Chaki P, Massaga JJ, et al. Nationwide school malaria parasitaemia survey in public primary schools, the United Republic of Tanzania. Malar J. 2018;17:452. sourceSupported
• cites [17] Diggle PJ, Giorgi E. Model-based geostatistics for prevalence mapping in low-resource settings. J Am Stat Assoc. 2016;111:1096–120. sourceNot checked — no full text of the source

It may state two separate claims as one.

Modelled Plasmodium falciparum parasite rate (PfPR) maps are increasingly becoming available and provide information on the epidemiological situation of countries.

“Modelled Plasmodium falciparum parasite rate (PfPR) maps are increasingly becoming available and provide information on the epidemiological situation of countries.”

• Also stated in: § Background · plain

  “In the last 10–15 years, maps showing the proportion of individuals infected at a given point in time are increasingly replacing or becoming available alongside qualitative, eco-climatic risk and routine data maps across a number of countries in SSA [11].”

• cites [11] Omumbo JA, Noor AM, Fall IS, Snow RW. How well are malaria maps used to design and finance malaria control in Africa? PLoS ONE. 2013;8:e53198. sourceSupported

Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

Malawi has relatively homogeneous prevalence of malaria with higher burden along Lake Malawi in the Central and Southern regions.

“Relatively homogeneous prevalence of malaria with higher burden along Lake Malawi in the Central and Southern regions [54]”

• cites [54] Give Chipeta M, Giorgi E, Mategula D, Macharia PM, Ligomba C, Munyenyembe A, et al. Open Peer Review Geostatistical analysis of Malawi’s changing malaria transmission from 2010 to 2017. Wellcome Open Res. 2019;4:57. sourceSupported

It may state two separate claims as one.

Declining malaria prevalence and pressure on external funding have increased the need for efficiency in malaria control in sub-Saharan Africa.

“Declining malaria prevalence [1–3] and malaria mortality [4], pressure on external funding and renewed interest in malaria elimination [5, 6] have highlighted the need for increased efficiency of malaria control in sub-Saharan Africa (SSA) [7–9].”

• cites [1] Weiss DJ, Lucas TCD, Nguyen M, Nandi AK, Bisanzio D, Battle KE, et al. Mapping the global prevalence, incidence, and mortality of Plasmodium falciparum, 2000–17: a spatial and temporal modelling study. Lancet. 2019;394:322–31. sourceSupported
• cites [2] World Health Organization. World malaria report 2019. Geneva: World Health Organization; 2019. sourceNot checked — no full text of the source
• cites [3] Snow RW, Sartorius B, Kyalo D, Maina J, Amratia P, Mundia CW, et al. The prevalence of Plasmodium falciparum in sub-Saharan Africa since 1900. Nature. 2017;550:515–8. sourceSupported
• cites [4] Gething PW, Casey DC, Weiss DJ, Bisanzio D, Bhatt S, Cameron E, et al. Mapping Plasmodium falciparum mortality in Africa between 1990 and 2015. N Engl J Med. 2016;375:2435–45. sourceSupported
• cites [7] Walker PGT, Griffin JT, Ferguson NM, Ghani AC. Estimating the most efficient allocation of interventions to achieve reductions in Plasmodium falciparum malaria burden and transmission in Africa: a modelling study. Lancet Glob Health. 2016;4:e474–84. sourceNot checked — no full text of the source
• cites [8] Scott N, Hussain SA, Martin-Hughes R, Fowkes FJI, Kerr CC, Pearson R, et al. Maximizing the impact of malaria funding through allocative efficiency: using the right interventions in the right locations. Malar J. 2017;16:368. sourceSupported
• cites [9] Clements ACA, Reid HL, Kelly GC, Hay SI. Further shrinking the malaria map: How can geospatial science help to achieve malaria elimination? Lancet Infect Dis. 2013;13:709–18. sourceNot checked — no full text of the source

It may state two separate claims as one.

High quality and timely data at high granular resolution are often not available, and policy makers therefore need to make decisions based on the maps using the data available or on modelled data.

“However, high quality and timely data at high granular resolution are often not available [23] and policy makers therefore need to make decisions based on the maps using the data available or on modelled data.”

• cites [23] Wickremasinghe D, Hashmi IE, Schellenberg J, Avan BI. District decision-making for health in low-income settings: a systematic literature review. Health Policy Plan. 2016;31:ii12–24. sourceSupported

Probably not a substantial claim. The paper’s conclusions may not depend on it.

Population at risk, number of malaria cases and deaths and malaria prevalence maps were utilized conjointly to quantify malaria commodities in a specific area.

“Indeed, population at risk, number of malaria cases and deaths and malaria prevalence maps were utilized conjointly to quantify malaria commodities in a specific area.”

It may state two separate claims as one.

In DRC and Malawi, the NMCP did not feel sufficiently involved in research generally, and specifically in the development of the PfPR maps.

“By contrast, in the DRC and Malawi, despite the involvement of the Malaria Alert Centre (College of Medicine) in Malawi, there was a keen sense from the interviews that the NMCP did not feel sufficiently involved in research generally, and specifically in the development of the PfPR maps.”

It may state two separate claims as one.

In Malawi, some stakeholders either did not know of the existence of district-level modelled PfPR maps or did not feel that the data used to develop the map was accurate enough to be representative at the district level.

“However, in Malawi some stakeholders either did not know of their existence or did not feel that the data used to develop the map was accurate enough to be representative at the district level.”

It may state two separate claims as one.

Malaria maps were used for project monitoring or planning, supply quantification, financial justification, and budget advocacy purposes.

“These included project monitoring or planning, supply quantification, financial justification, and budget advocacy purposes.”

It may state two separate claims as one.

Anti-malarials and diagnostics for case management were the first priority, followed by LLINs and IPTp for prevention.

“Anti-malarials and diagnostics for case management were the first priority, followed by LLINs and IPTp for prevention.”

Probably not a substantial claim. It may state two separate claims as one.

DHS and MIS data were representative at national or higher sub-national levels but not at district-level, and this was perceived as a limitation of the national survey data.

“The fact that DHS and MIS data were representative at national or at the higher sub-national levels (e.g. region or province) but not at district-level was perceived as a limitation of the national survey data.”

It may state two separate claims as one.

Malaria risk maps were developed using either multiple PfPR data points, DHS prevalence data at one point in time, or routine health information system data.

“Malaria risk maps were developed using either multiple PfPR data points, DHS prevalence data at one point in time, or by using routine health information system data.”

Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

DRC officers reportedly felt that the PfPR data available were not sufficient to develop a representative map and decided to use the most recent DHS data (2013-2014), despite it only providing provincial-level resolution, and have pushed to make the 2020 DHS/MIS survey representative of the 26 provinces.

“DRC officers reportedly felt that the PfPR data available were not sufficient to develop a representative map and as such they decided to use the most recent DHS data (2013–2014), despite it only providing provincial-level resolution, however, they have pushed to make the 2020 DHS/MIS survey representative of the 26 provinces.”

Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

The DRC strategy stated that all interventions would be allocated universally, except IRS in urban and pre-elimination areas, and LLINs distribution in schools in tropical areas.

“The strategy stated that all interventions would be allocated universally, with the exception of IRS, which would be implemented in urban and pre-elimination areas, and LLINs distribution in schools in the tropical areas [37].”

• cites [37] Programme nationale de lutte contre le paludisme (PNLP). Plan strategique national de lutte contre le paludisme. Kinshasa, 2016;81.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

It may state two separate claims as one.

In Kenya, delivery of LLINs and IPTp was only implemented in the 16 endemic counties of the Lake and Coast regions (out of 47 counties) and IRS was implemented in two counties (Homa Bay and Migori).

“In Kenya, the delivery of LLINs and IPTp was only implemented in the 16 endemic counties of the Lake and Coast regions (out of 47 counties in total) and IRS was implemented in two counties (Homa Bay and Migori).”

It may state two separate claims as one.

Participants in Malawi and DRC perceived targeting to be associated with limited resources, while in Kenya participants felt the use of a targeted approach was primarily to increase efficiency and value for money in malaria control.

“Participants in Malawi and DRC perceived targeting to be associated with limited resources, while in Kenya participants felt the use of a targeted approach was primarily to increase efficiency and value for money in malaria control.”

It may state two separate claims as one.

In Kenya, the NMCP and other stakeholders interviewed were proud to have shifted to a targeted approach for malaria interventions and appreciated the modelled PfPR maps.

“In Kenya, the NMCP and other stakeholders interviewed were proud to have shifted to a targeted approach for malaria interventions and appreciated the modelled PfPR maps.”

It may state two separate claims as one.

The decision to use malaria risk maps was motivated by their availability (or potential to be developed), the technical characteristics of the maps, and the alignment of the maps with stakeholder expectations.

“The decision to use malaria risk maps was motivated by their availability (or potential to be developed), the technical characteristics of the maps, and the alignment of the maps with stakeholder expectations.”

It may state two separate claims as one.

Targeting was applied to all preventative interventions (LLINs, IPTp, IRS) in Kenya; while limited to IRS, or LLINs in schools, or IPTp at the community level in Malawi and DRC.

“Targeting was applied to all preventative interventions (LLINs, IPTp, IRS) in the case of Kenya; while limited to IRS, or LLINs in schools, or IPTp at the community level in the case of Malawi and DRC.”

It may state two separate claims as one.

In Kenya, modelled PfPR maps for the county level were available and appreciated.

“In Kenya, modelled PfPR maps for the county level were available and appreciated.”

It may state two separate claims as one.

Three different types of maps were used to show malaria epidemiological strata: a modelled PfPR prevalence map in Kenya, a routine health system incidence map in Malawi, and a Demographic and Health Survey prevalence map in DRC.

“Three different types of maps were used to show malaria epidemiological strata: malaria prevalence using a PfPR modelled map (Kenya); malaria incidence using routine health system data (Malawi); and malaria prevalence using data from the most recent Demographic and Health Survey (DRC).”

• Also stated in: § Risk maps included in the National Malaria Strategic Plans · plain

  “However, each country used a different type of malaria risk map, based on different kinds of data: a modelled PfPR map in Kenya, an incidence map based on routine data in Malawi and a prevalence map based on the Demographic Health Survey (DHS) data in DRC (Fig. 1).”

Probably not a substantial claim. The paper’s conclusions may not depend on it.

According to the Malawi strategy, interventions would be allocated universally, except IRS, which would be implemented in high burden districts or areas.

“According to the strategy, interventions would be allocated universally, with the exception of IRS, which would be implemented in high burden districts or areas [36].”

• cites [36] Governement of Malawi, Ministry of Health. Malawi Malaria Strategic Plan 2017–2022. Lilongwe 2017.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim. The paper’s conclusions may not depend on it.

NMCP officers and other stakeholders in Malawi reported using incidence data from the routine health information system because they perceived this to be the only way to develop a map at district level that they felt they could trust.

“NMCP officers and other stakeholders in Malawi reported using incidence data from the routine health information system because they perceived this to be the only way to develop a map at district level that they felt they could trust.”

It may state two separate claims as one.

Routine health data were perceived as understandable and useful in indicating the distribution of malaria burden and guiding decisions despite the acknowledgement that the data was not always of good quality.

“Conversely, routine health data were perceived as understandable and useful in indicating the distribution of malaria burden and guiding decisions despite the acknowledgement that the data was not always of good quality.”

It may state two separate claims as one.

Maps were used to advocate for funds at the sub-national level, in countries with some degree of devolution, and by community-based organizations to advocate for funds or for social accountability.

“Maps were used to advocate for funds at the sub-national level, in countries with some degree of devolution, and by community-based organizations to advocate for funds or for social accountability.”

It may state two separate claims as one.

In DRC and Malawi, LLINs and IPTp were delivered in the entire country through universal coverage, but maps were used to identify high burden areas where additional interventions or delivery sites were appropriate, such as LLINs in schools and IPTp at community level in DRC and IRS in Malawi.

“In DRC and Malawi, LLINs and IPTp were delivered in the entire country through using a universal coverage approach, however maps were utilized to identify high burden areas where additional interventions or delivery sites were appropriate, such as LLINs distributed in schools and the delivery of IPTp at the community level in DRC (Table 4) and IRS in Malawi.”

It may state two separate claims as one.

Stakeholders in Malawi and DRC preferred maps that showed what they expected to see: a decreased number of cases in Malawi and alignment with routine data in DRC.

“Stakeholders in both countries mentioned that they preferred maps that showed what they expected to see, a decreased number of cases in Malawi and alignment with routine data in DRC.”

It may state two separate claims as one.

Use of malaria risk maps was driven by perceived need, understanding (quality and relevance), ownership and trust in the data used to develop the maps.

“Perceived utility of malaria risk maps was associated with the epidemiological structure of the country and use was driven by perceived need, understanding (quality and relevance), ownership and trust in the data used to develop the maps.”

It may state two separate claims as one.

The visual nature of the maps was seen to encourage their use as powerful tools for resource mobilization and advocacy, and training purposes.

“The visual nature of the maps was seen to encourage their use as powerful tools for resource mobilization and advocacy, and training purposes.”

Probably not a substantial claim. The paper’s conclusions may not depend on it.

Timeliness of the monthly routine data was perceived as an issue by some policy makers.

“Timeliness of the monthly routine data (the period needed to send data from health facilities to the central level) was perceived as an issue by some policy makers.”

It may state two separate claims as one.

Stakeholders in all three countries highlighted the importance of the sense of ownership of the maps by NMCP and of engagement of researchers and technical advisors in supporting the NMCP to develop risk maps.

“Stakeholders in all three countries highlighted the importance of the sense of ownership of the maps by NMCP and of engagement of researchers and technical advisors in supporting the NMCP to develop risk maps.”

It may state two separate claims as one.

Alignment of the maps with stakeholder expectations included alignment with the expected malaria epidemiological situation in the country, knowledge, trust and perceived ownership of the data and of the process of developing the maps.

“while the alignment of the maps with stakeholder expectations included a range of related factors such as: alignment with the expected malaria epidemiological situation in the country (based on eco-climatic zone, routine data, or indications from sentinel sites); knowledge, trust and perceived ownership of the data and of the process of developing the maps.”

It may state two separate claims as one.

Risk maps were primarily used for strategic planning, in particular to aid selection of geographic areas or population sub-groups for delivery of an intervention (targeting); operational planning and advocacy were also important uses.

“Risk maps were primarily used for strategic planning, in particular to aid in the selection of geographic areas or population sub-groups for delivery of an intervention (targeting); however, operational planning and advocacy were also identified as important uses.”

Probably not a substantial claim. The paper’s conclusions may not depend on it.

IRS in Malawi was scaled up from one to seven highly endemic districts in 2012.

“Specifically, IRS in Malawi was scaled up from one to seven highly endemic districts in 2012, while in DRC, IRS was implemented by mining companies in the areas where they were operating.”

Probably not a substantial claim. It may state two separate claims as one.

Kenyan NMCP officers mentioned long-term (over 20 years) and daily collaboration with KEMRI-Wellcome Trust, with researchers contributing to TWGs by reviewing interventions, routine data, discussing changes in strategy and policy, and generating and sharing new national and global evidence.

“Kenyan NMCP officers mentioned the long term (over 20 years) and daily collaboration with KEMRI- Wellcome Trust; how the researchers have consistently contributed to the TWGs by reviewing interventions, routine data, discussing changes in strategy and policy and generating and sharing new national and global evidence.”

It may state two separate claims as one.

The ease with which malaria risk could be visualized was highly appreciated and often used for training purposes to catch attention of the audience.

“Finally, the ease with which malaria risk could be visualized was highly appreciated and often used for training purposes to catch attention of the audience.”

Probably not a substantial claim. The paper’s conclusions may not depend on it.

In DRC, IRS was implemented by mining companies in the areas where they were operating.

“Specifically, IRS in Malawi was scaled up from one to seven highly endemic districts in 2012, while in DRC, IRS was implemented by mining companies in the areas where they were operating.”

Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

In Malawi, although LLINs and IPTp were universally implemented, targeting was perceived by some as a better strategy given resource constraints and geographical variations in risk.

“In Malawi, although LLINs and IPTp were universally implemented, targeting was perceived, by some, as a better strategy given the resource contraints and geographical variations in risk, as explained by one official:”

Probably not a substantial claim. It may state two separate claims as one.

Concerns were raised about the granularity of the data and some participants questioned how representative the maps were of populations at the sub-national level.

“Concerns were raised about the granularity of the data and some participants questioned how representative the maps were of populations at the sub-national level.”

Probably not a substantial claim. The authors may not put it forward as true. It may state two separate claims as one.

These stakeholders felt universal coverage of LLINs and IPTp was the most appropriate strategy at this stage, weakening the need for PfPR risk maps.

“They felt that universal coverage of LLINs and IPTp was the most appropriate strategy at this stage, weakening the need for PfPR risk maps”

It may state two separate claims as one.

Maps were also used for operational planning, supply quantification, financial justification and advocacy.

“Maps were also used for operational planning, supply quantification, financial justification and advocacy.”

Probably not a substantial claim. The paper’s conclusions may not depend on it.

Stakeholders, including NMCPs and donors, reported that interventions were prioritized based on their perceived efficacy, primarily ensuring availability of commodities.

“Stakeholders, including NMCPs and donors, reported that interventions were prioritized based on their perceived efficacy, which primarily meant ensuring the availability of commodities.”

It may state two separate claims as one.

In Kenya the map was used to target preventative interventions, including LLINs and IPTp; in Malawi and DRC maps were used to target IRS and LLINs distributions in schools.

“In Kenya the map was used to target preventative interventions, including long-lasting insecticide-treated nets (LLINs) and intermittent preventive treatment in pregnancy (IPTp), whilst in Malawi and DRC the maps were used to target in-door residual spraying (IRS) and LLINs distributions in schools.”

Probably not a substantial claim. The paper’s conclusions may not depend on it.

Intervention choices were based on evidence from efficacy and effectiveness studies, as well as WHO Global Malaria Programme guidelines.

“Intervention choices were based on evidence from efficacy and effectiveness studies, as well as WHO Global Malaria Programme (GMP) guidelines.”

Probably not a substantial claim.

Some stakeholders in DRC and Malawi perceived prioritization and targeting of high impact interventions (LLINs and IPTp) as not suitable in a country where the risk of malaria is high almost everywhere.

“However, some other stakeholders in DRC and Malawi perceived the prioritization and targeting of high impact interventions (LLINs and IPTp) not suitable in a country where the risk of malaria is high almost everywhere.”

It may state two separate claims as one.

Maps were specifically used for annual reviews and during the mid-term and final reviews of the NMSP.

“Maps were specifically used for annual reviews and during the mid-term and final reviews of the NMSP.”

Probably not a substantial claim.

Malaria risk maps of consecutive years were key to showing progress and readjusting the strategy over time.

“Malaria risk maps of consecutive years were key to showing progress and readjusting the strategy over time, as Kenyan officials explained:”

Probably not a substantial claim. The paper’s conclusions may not depend on it.

Routine health data were perceived by some stakeholders as advantageous due to their being more recent and timely compared to national survey data, which are produced every 3 to 5 years.

“These data were perceived by some stakeholders as advantageous due to their being more recent and timely compared to national survey data, which are produced every 3 to 5 years.”

Probably not a substantial claim. The paper’s conclusions may not depend on it.

Technical characteristics of the maps included the nature and quality of the data from which the maps were developed and the granularity of the data.

“Technical characteristics of the maps included: the nature and quality of the data from which the maps were developed and the granularity of the data;”

It may state two separate claims as one.

Malaria surveys were generally well understood and trusted, but they were not available at the desired level of resolution and in the required timeline.

“Malaria surveys were generally well understood and trusted, however they were not available at the desired level of resolution and in the required timeline.”

It may state two separate claims as one.

The NMCP in Kenya perceived the need of moving to a targeted approach to interventions, had a significant amount of data available to develop sub-national maps, understood and trusted the results of the modelled maps, and was reported by stakeholders as having allocated a budget for subsequent development of maps.

“The NMCP in Kenya perceived the need of moving to a targeted approach to interventions, had a significant amount of data available to develop sub-national maps, understood and trusted the results of the modelled maps, and was reported by stakeholders as having allocated a budget for subsequent development of maps.”

It may state two separate claims as one.

Malawi and DRC had homogeneous distributions of malaria risk, but homogeneity was perceived differently by stakeholders according to their interests and roles.

“Malawi and DRC had homogeneous distributions of malaria risk; however, homogeneity was perceived differently by the stakeholders according to their interests and roles.”

Probably not a substantial claim. The paper’s conclusions may not depend on it.

The need to adjust for reporting rates, missing data from private sector, and the proportion of malaria that was confirmed versus suspected was recognized.

“The need to adjust for reporting rates, missing data from private sector, and the proportion of malaria that was confirmed versus suspected was recognized.”

It may state two separate claims as one.

This ability depended on the transparency of data and how the maps were developed, and on the availability of timely and geolocated data at the desired level of granularity.

“In turn, this depended on the transparency of data and how the maps were developed, and on the availability of timely and geolocated data at the desired level of granularity.”

It may state two separate claims as one.

Drivers of the use of malaria risk maps for strategic planning were perceived need for risk maps; an understanding of what data was used to develop the map, including its limitations; and trust and ownership in the data and how it was used in the maps.

“Drivers of the use of malaria risk maps for strategic planning were: perceived need for risk maps; an understanding of what data was used to develop the map, including its limitations; and trust and ownership in the data and how it was used in the maps (Fig. 2).”

It may state two separate claims as one.

The NMCP in Malawi did not trust the results of the PfPR modelling because the modelled maps contradicted a Roll Back Malaria report, and preferred instead to use routine incidence data to develop a map at district level.

“Conversely, the NMCP in Malawi did not trust the results of the PfPR modelling, because the modelled maps contradicted a Roll Back Malaria report, and preferred instead to use routine incidence data to develop a map at district level.”

It may state two separate claims as one.

Perceived utility of malaria risk maps was associated with the epidemiological structure of the country and use was driven by perceived need, understanding (quality and relevance), ownership and trust in the data.

“Perceived utility of malaria risks maps was associated with the epidemiological structure of the country and use was driven by perceived need, understanding (quality and relevance), ownership and trust in the data.”

It may state two separate claims as one.

In Malawi, the Malaria Alert Centre-College of Medicine, a nationally recognized long-term partner, was involved in the development of the modelled map and profile; however, this element was not sufficient.

“In Malawi, the Malaria Alert Centre- College of Medicine, a nationally recognized long-term partner was involved in the development of the modelled map and profile; however, this element was not sufficient.”

It may state two separate claims as one.

The NMCP in DRC did not trust the quality of their routine data and chose to use the most recent DHS survey data to develop a map.

“They also did not trust the quality of their routine data and chose to use the most recent DHS survey data to develop a map.”

It may state two separate claims as one.

Routine data were understood, although not always trusted.

“Routine data were understood, although not always trusted.”

Probably not a substantial claim. It may state two separate claims as one.

Strengthening surveillance and use of data was perceived as important when allocating limited resources and to monitor progress of control interventions.

“However, strengthening surveillance and use of data was perceived as important when allocating limited resources and to monitor progress of the control interventions.”

Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

The interviewers were perceived as colleagues by researchers and officers of international organizations, while government officers perceived them as external figures.

“The interviewers were perceived as colleagues by researchers and officers of international organizations, while government officers perceived them as external figures.”

It may state two separate claims as one.

Policymakers were comfortable using maps based on routine data because they understood the limitations and were able to make their recommendations based on this knowledge.

“But, whilst hoping that these issues would be resolved over time, policymakers were comfortable using maps based on this data because they understood the limitations and were able to make their recommendations based on this knowledge.”

Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.

The three countries have different malaria epidemiological profiles (quasi homogenous in Malawi and DRC and heterogeneous in Kenya) impacting on the perceived need for PfPR maps to stratify malaria control interventions.

“The three countries have different malaria epidemiological profiles (quasi homogenous in Malawi and DRC and heterogeneous in Kenya) impacting on the perceived need for PfPR maps to stratify malaria control interventions.”

Probably not a substantial claim. The paper may give no reason why it holds. It may state two separate claims as one.

Malaria risk maps were produced and used for malaria decision-making, such as strategic planning, targeting, quantification, monitoring and advocacy.

“Malaria risk maps were produced and used for malaria decision-making, such as strategic planning, targeting, quantification, monitoring and advocacy.”

It may state two separate claims as one.

Although national level modelled PfPR maps were available in all three countries, they were not used in two of the countries.

“Although national level modelled PfPR maps were available in all three countries, they were not used in two of the countries.”

It may state two separate claims as one.

Some stakeholders did not perceive any need for risk maps, while others expressed a need for highly granular maps defining malaria risk at the sub-district level.

“Therefore, some stakeholders did not perceive any need for risk maps, while others expressed a need for highly granular maps defining malaria risk at the sub-district level.”

It may state two separate claims as one.

Although most stakeholders were aware of the limitations in quality, they considered routine data as the only data able to give an idea of the malaria risk at district level.

“However, although most of the stakeholders were aware of the limitations in quality, they also considered them as the only data able “to give an idea” of the malaria risk at district level.”

Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

Kenya has high variability in malaria parasite prevalence across the country, with endemic counties around Lake Victoria and on the coast, epidemic-prone counties in the highland areas, seasonal counties and low risk counties around Nairobi.

“High variability in malaria parasite prevalence across the country, with endemic counties around Lake Victoria and on the coast, epidemic-prone counties in the highland areas, seasonal counties and low risk counties around Nairobi [51–53]”

• cites [51] Macharia PM, Giorgi E, Noor AM, Waqo E, Kiptui R, Okiro EA, et al. Spatio-temporal analysis of Plasmodium falciparum prevalence to understand the past and chart the future of malaria control in Kenya. Malar J. 2018;17:340. sourceNot checked yet

  Checked before — its earlier verdict is held back until a new check runs.

• cites [52] Ministry of Health Kenya. The epidemiology and control profile of malaria in Kenya: reviewing the evidence to guide the future vector control. Nairobi, 2016.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [53] Noor AM, Gething PW, Alegana VA, Patil AP, Hay SI, Muchiri E, et al. The risks of malaria infection in Kenya in 2009. BMC Infect Dis. 2009;9:180. sourceNot checked yet

  Checked before — its earlier verdict is held back until a new check runs.

Probably not a substantial claim. The paper may give no reason why it holds.

In contexts lacking complete, good quality routine health data, modelled PfPR maps provide an indication of the epidemiological characteristics of malaria transmission sub-nationally.

“In contexts lacking complete, good quality routine health data, modelled PfPR maps provide an indication of the epidemiological characteristics of malaria transmission sub-nationally.”

Probably not a substantial claim. The paper’s conclusions may not depend on it.

Maps have long been used as evidence by national stakeholders to inform policy priorities, strategies and interventions.

“Maps have long been used as evidence by national stakeholders to inform policy priorities, strategies and interventions [3, 18], they represent one form of relevant evidence for health decision-making.”

• cites [3] Snow RW, Sartorius B, Kyalo D, Maina J, Amratia P, Mundia CW, et al. The prevalence of Plasmodium falciparum in sub-Saharan Africa since 1900. Nature. 2017;550:515–8. sourceNot checked yet

  Checked before — its earlier verdict is held back until a new check runs.

• cites [18] Snow RW, Noor AM. Malaria risk mapping in Africa: The historical context to the Information for Malaria (INFORM) project. Working Paper in support of the INFORM Project funded by the Department for International Development and the Wellcome Trust, Nairobi, Kenya, 2015.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim. The paper’s conclusions may not depend on it.

According to WHO guidelines, all three countries are in the malaria control phase.

“According to the World Health Organization (WHO) guidelines, all three countries are in the malaria control phase [29].”

• cites [29] WHO. Global malaria programme. A framework for malaria elimination. Geneva: World Health Organization; 2017.Not checked yet

Probably not a substantial claim. The paper’s conclusions may not depend on it.

Findings were validated by stakeholders (NMCP representatives and researchers) during a three-day workshop in September 2018.

“Findings were validated by stakeholders (NMCP representatives and researchers) during a three-day workshop in September 2018.”

Probably not a substantial claim. The paper’s conclusions may not depend on it.

DRC has homogeneous hyperendemic to holoendemic malaria transmission across the country, except the mountainous area in the eastern provinces (0.2% of the population) and the capital city Kinshasa.

“Homogeneous hyperendemic to holoendemic malaria transmission across the country, with the exception of the mountainous area in the eastern provinces (0.2% of the population), and in the capital city Kinshasa [55, 56]”

• cites [55] Taylor SM, Messina JP, Hand CC, Juliano JJ, Muwonga J, Tshefu AK, et al. Molecular malaria epidemiology: mapping and burden estimates for the democratic Republic of the Congo, 2007. PLoS ONE. 2011;6:e16420. sourceNot checked yet

  Checked before — its earlier verdict is held back until a new check runs.

• cites [56] Programme Nationale de Lutte contre le Paludisme (PNLP) An epidemiological profile of malaria in the Democratic Republic of Congo, 2014.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

It may state two separate claims as one.

The data and indicators utilized by the RBM study and the modelled PfPR maps were different and not comparable.

“The data and the indicators utilized by the two studies were different and not comparable.”

Probably not a substantial claim. The paper’s conclusions may not depend on it.

The fact that one interviewer was external to the country could have allowed the respondents to speak more freely about their perceptions.

“However, the fact that one interviewer was external to the country could have allowed the respondents to speak more freely about their perceptions.”

Probably not a substantial claim. The paper’s conclusions may not depend on it.

It is possible that the presence of the international interviewer could have affected the way the participants replied to the questions.

“It is possible that the presence of the international interviewer could have affected the way the participants replied to the questions.”

Probably not a substantial claim. The paper’s conclusions may not depend on it.

Global policies, such as the Global Technical Strategy for malaria 2016-2030, requirements from donors, the Global Fund in particular, and increasing support for generation and use of data, would have influenced the perceived needs for production and use of malaria risk maps or stratification.

“Finally, global policies, such as the Global Technical Strategy for malaria 2016–2030, requirements from donors, the Global Fund in particular, and the increasing support in the field for the generation and use of data (for instance through USAID funded project of Measure evaluation) would have influenced the perceived needs for production (and possibly use) malaria risk maps or stratification.”

Probably not a substantial claim. It may be too vague to check against evidence.

The political dimension of the choice and use of data by policy makers should be recognized.

“The political dimension of the choice and use of data by policy makers should be recognized [49], as Newman said “while supply of research information is important, it will only be used to inform policy if it is accessed, valued and understood by policymakers” [50].”

• cites [49] Paul C, Kramer R, Lesser A, Mutero C, Miranda ML, Dickinson K. Identifying barriers in the malaria control policymaking process in East Africa: insights from stakeholders and a structured literature review. BMC Public Health. 2015;15:862. sourceNot checked yet

  Checked before — its earlier verdict is held back until a new check runs.

• cites [50] Newman K, Fisher C, Shaxson L. Stimulating demand for research evidence: What role for capacity-building? IDS Bull. 2012;43:17–24. sourceNot checked — no full text of the source

Probably not a substantial claim. The paper’s conclusions may not depend on it.

Not all of the stakeholders who were identified and contacted were available for interview.

“Not all of the stakeholders who were identified and contacted were available for interview.”

It may state two separate claims as one.

This collaboration ensured NMCP involvement in the collection of data and definition of the type of maps to be developed, and consequently facilitated understanding of the data and the process used to develop the map.

“This collaboration ensured NMCP involvement in the collection of data and definition of the type of maps to be developed, and consequently facilitated understanding of the data and the process used to develop the map.”

Probably not a substantial claim. It may be too vague to check against evidence.

Modelled malaria risk maps could be one tool used to support malaria decision-making across countries.

“Modelled malaria risk maps could be one tool used to support malaria decision-making across countries.”

Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it.

The lack of perceived need for malaria risk maps by some stakeholders in countries with homogenous malaria transmission is understandable, as high impact interventions are and will be implemented universally for a significant period of time.

“The lack of perceived need for malaria risk maps by some stakeholders in countries with homogenous malaria transmission is understandable, as high impact interventions are and will be implemented universally for a significant period of time.”

• AssumptionRests on an assumption: In countries with homogenous malaria transmission, high impact interventions are and will be implemented universally for a significant period of time.
• AssumptionRests on an assumption: Universal coverage among populations at greater risk is the main objective for countries such as DRC and Malawi.

Probably not a substantial claim.

Countries like Malawi and DRC, where the risk is still very high almost everywhere, are facing multiple challenges.

“Conversely countries like Malawi and the DRC, where the risk is still very high almost everywhere, are facing multiple challenges.”

Probably not a substantial claim. It may be too vague to check against evidence.

Tailored interventions may be appropriate in countries with heterogeneous risk, such as in many Sahelian countries in West Africa and the east and Horn of Africa, including Kenya.

“However, tailored interventions may be appropriate in countries with heterogeneous risk, such as in many Sahelian countries in West Africa and the east and Horn of Africa, including Kenya.”

Probably not a substantial claim. It may be too vague to check against evidence. It may state two separate claims as one.

The availability of timely, good quality, highly granular data would help to construct clearer maps and allow stakeholders to appreciate the quality of the map and understand what they are showing.

“The availability of timely, good quality, highly granular data would help to construct clearer maps and allow stakeholders to appreciate the quality of the map and understand what they are showing.”

Probably not a substantial claim. The paper’s conclusions may not depend on it.

Perceptions of the utility of these maps may have differed in countries with varied geographical and epidemiological contexts.

“Perceptions of the utility of these maps may have differed in countries with varied geographical and epidemiological contexts.”

Probably not a substantial claim. It may be too vague to check against evidence.

Evidence and information to guide interventions, including malaria risk maps trusted and understood by the policy makers, are key in supporting national stakeholders to achieve their goal of effective malaria control.

“Evidence and information to guide interventions, including malaria risk maps trusted and understood by the policy makers, are key in supporting national stakeholders to achieve their goal of effective malaria control.”

Probably not a substantial claim. The paper’s conclusions may not depend on it.

It is possible that those interviewed were more interested in malaria epidemiology and risk maps or in talking with researchers and therefore held different views to those who did not participate.

“It is possible that those interviewed were more interested in malaria epidemiology and risk maps or in talking with researchers and therefore held different views to those who did not participate.”

Probably not a substantial claim. The paper may give no reason why it holds. It may state two separate claims as one.

The potential to create maps that identify sub-national pockets of high risk of malaria is dependent upon the quality of the routine data available; prevalence data will not allow this identification.

“The potential to create maps that identify sub-national pockets of high risk of malaria is dependent upon the quality of the routine data available, prevalence data will not allow this identification.”