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Bayode T, Siegmund A. Identifying childhood malaria hotspots and risk factors in a Nigerian city using geostatistical modelling approach. Sci Rep 2024; 14:5445. [PMID: 38443428 PMCID: PMC10914794 DOI: 10.1038/s41598-024-55003-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/19/2024] [Indexed: 03/07/2024] Open
Abstract
Malaria ranks high among prevalent and ravaging infectious diseases in sub-Saharan Africa (SSA). The negative impacts, disease burden, and risk are higher among children and pregnant women as part of the most vulnerable groups to malaria in Nigeria. However, the burden of malaria is not even in space and time. This study explores the spatial variability of malaria prevalence among children under five years (U5) in medium-sized rapidly growing city of Akure, Nigeria using model-based geostatistical modeling (MBG) technique to predict U5 malaria burden at a 100 × 100 m grid, while the parameter estimation was done using Monte Carlo maximum likelihood method. The non-spatial logistic regression model shows that U5 malaria prevalence is significantly influenced by the usage of insecticide-treated nets-ITNs, window protection, and water source. Furthermore, the MBG model shows predicted U5 malaria prevalence in Akure is greater than 35% at certain locations while we were able to ascertain places with U5 prevalence > 10% (i.e. hotspots) using exceedance probability modelling which is a vital tool for policy development. The map provides place-based evidence on the spatial variation of U5 malaria in Akure, and direction on where intensified interventions are crucial for the reduction of U5 malaria burden and improvement of urban health in Akure, Nigeria.
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Affiliation(s)
- Taye Bayode
- Institute of Geography & Heidelberg Centre for Environment (HCE), Heidelberg University, Heidelberg, Germany.
- Department of Geography-Research Group for Earth Observation (rgeo), UNESCO Chair on World Heritage and Biosphere Reserve Observation and Education, Heidelberg University of Education, Heidelberg, Germany.
| | - Alexander Siegmund
- Institute of Geography & Heidelberg Centre for Environment (HCE), Heidelberg University, Heidelberg, Germany
- Department of Geography-Research Group for Earth Observation (rgeo), UNESCO Chair on World Heritage and Biosphere Reserve Observation and Education, Heidelberg University of Education, Heidelberg, Germany
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Chiziba C, Mercer LD, Diallo O, Bertozzi-Villa A, Weiss DJ, Gerardin J, Ozodiegwu ID. Socioeconomic, Demographic, and Environmental Factors May Inform Malaria Intervention Prioritization in Urban Nigeria. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:78. [PMID: 38248543 PMCID: PMC10815685 DOI: 10.3390/ijerph21010078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/22/2023] [Accepted: 01/07/2024] [Indexed: 01/23/2024]
Abstract
Urban population growth in Nigeria may exceed the availability of affordable housing and basic services, resulting in living conditions conducive to vector breeding and heterogeneous malaria transmission. Understanding the link between community-level factors and urban malaria transmission informs targeted interventions. We analyzed Demographic and Health Survey Program cluster-level data, alongside geospatial covariates, to describe variations in malaria prevalence in children under 5 years of age. Univariate and multivariable models explored the relationship between malaria test positivity rates at the cluster level and community-level factors. Generally, malaria test positivity rates in urban areas are low and declining. The factors that best predicted malaria test positivity rates within a multivariable model were post-primary education, wealth quintiles, population density, access to improved housing, child fever treatment-seeking, precipitation, and enhanced vegetation index. Malaria transmission in urban areas will likely be reduced by addressing socioeconomic and environmental factors that promote exposure to disease vectors. Enhanced regional surveillance systems in Nigeria can provide detailed data to further refine our understanding of these factors in relation to malaria transmission.
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Affiliation(s)
- Chilochibi Chiziba
- Department of Preventive Medicine and Institute for Global Health, Northwestern University, Chicago, IL 60611, USA
| | | | - Ousmane Diallo
- Department of Preventive Medicine and Institute for Global Health, Northwestern University, Chicago, IL 60611, USA
| | | | - Daniel J. Weiss
- Telethon Kids Institute, Nedlands, WA 6009, Australia
- Faculty of Health Sciences, Curtin University, Bently, WA 6102, Australia
| | - Jaline Gerardin
- Department of Preventive Medicine and Institute for Global Health, Northwestern University, Chicago, IL 60611, USA
| | - Ifeoma D. Ozodiegwu
- Department of Preventive Medicine and Institute for Global Health, Northwestern University, Chicago, IL 60611, USA
- Department of Health Informatics and Data Science, Loyola University, Health Sciences Campus, Maywood, IL 60153, USA
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Akafity G, Kumi N, Ashong J. Diagnosis and management of malaria in the intensive care unit. JOURNAL OF INTENSIVE MEDICINE 2024; 4:3-15. [PMID: 38263976 PMCID: PMC10800773 DOI: 10.1016/j.jointm.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 08/17/2023] [Accepted: 09/02/2023] [Indexed: 01/25/2024]
Abstract
Malaria is responsible for approximately three-quarters of a million deaths in humans globally each year. Most of the morbidity and mortality reported are from Sub-Saharan Africa and Asia, where the disease is endemic. In non-endemic areas, malaria is the most common cause of imported infection and is associated with significant mortality despite recent advancements and investments in elimination programs. Severe malaria often requires intensive care unit admission and can be complicated by cerebral malaria, respiratory distress, acute kidney injury, bleeding complications, and co-infection. Intensive care management includes prompt diagnosis and early initiation of effective antimalarial therapy, recognition of complications, and appropriate supportive care. However, the lack of diagnostic capacities due to limited advances in equipment, personnel, and infrastructure presents a challenge to the effective diagnosis and management of malaria. This article reviews the clinical classification, diagnosis, and management of malaria as relevant to critical care clinicians, highlighting the role of diagnostic capacity, treatment options, and supportive care.
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Affiliation(s)
- George Akafity
- Department of Research, Monitoring, and Evaluation, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Nicholas Kumi
- Intensive Care Unit, Department of Critical Care and Anesthesia, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Joyce Ashong
- Department of Paediatrics and Child Health, Cape Coast Teaching Hospital, Cape Coast, Ghana
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Nsengimana A, Isimbi J, Uwizeyimana T, Biracyaza E, Hategekimana JC, Uwambajimana C, Gwira O, Kagisha V, Asingizwe D, Adedeji A, Nyandwi JB. Malaria rapid diagnostic tests in community pharmacies in Rwanda: availability, knowledge of community pharmacists, advantages, and disadvantages of licensing their use. Glob Health Res Policy 2023; 8:40. [PMID: 37700374 PMCID: PMC10496312 DOI: 10.1186/s41256-023-00324-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 08/22/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Presumptive treatment of malaria is often practiced in community pharmacies across sub-Saharan Africa (SSA).To address this issue, the World Health Organization (WHO) recommends that malaria Rapid Diagnostic Tests (m-RDTs) be used in these settings, as they are used in the public sector. However, their use remains unlicensed in the community pharmacies in Rwanda. This can lessen their availability and foster presumptive treatment. Therefore, this study investigated the availability of m-RDTs, knowledge of community pharmacists on the use of m-RDTs, and explored Pharmacists' perceptions of the advantages and disadvantages of licensing the use of m-RDTs in community pharmacies. METHODS This was a cross-sectional study among 200 licensed community pharmacists who were purposefully sampled nationwide from 11th February to 12th April 2022. Data was collected using an online data collection instrument composed of open-ended and closed-ended questions. Statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS) version 25.0. The chi-square test was used to evaluate the association between the availability of m-RDTs and independent variables of interest. Content analysis was used for qualitative data. RESULTS Although 59% were consulted by clients requesting to purchase m-RDTs, only 27% of the participants had m-RDTs in stock, 66.5% had no training on the use of m-RDTs, and 18.5% were not at all familiar with using the m-RDTs. Most of the participants (91.5%) agreed that licensing the use of m-RDTs in community pharmacies could promote the rational use of antimalarials. The chi-square test indicated that being requested to sell m-RDTs (x2 = 6.95, p = 0.008), being requested to perform m-RDTs (x2 = 5.39, p = 0.02),familiarity using m-RDTs (x2 = 17.24, p = 0.002), availability of a nurse in the Pharmacy (x2 = 11.68, p < 0.001), and location of the pharmacy (x2 = 9.13, p = 0.048) were all significantly associated with the availability of m-RDTs in the pharmacy. CONCLUSIONS The availability of m-RDTs remains low in community pharmacies in Rwanda, and less training is provided to community pharmacists regarding the use of m-RDTs. Nevertheless, community pharmacists had positive perceptions of the advantages of licensing the use of m-RDTs. Thus, licensing the use of m-RDTs is believed to be the first step toward promoting the rational use of antimalarial medicines in Rwanda.
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Affiliation(s)
- Amon Nsengimana
- USAID Global Health Supply Chain Program-Procurement and Supply Management, Kigali, Rwanda.
| | - Joyce Isimbi
- Department of Pharmacy, School of Medicine and Pharmacy, University of Rwanda, Kigali, Rwanda
| | | | - Emmanuel Biracyaza
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montréal, QC, Canada
| | | | - Charles Uwambajimana
- Department of Pharmacy, School of Medicine and Pharmacy, University of Rwanda, Kigali, Rwanda
| | - Olivia Gwira
- USAID Global Health Supply Chain Program-Procurement and Supply Management, Kigali, Rwanda
| | - Vedaste Kagisha
- Department of Pharmacy, School of Medicine and Pharmacy, University of Rwanda, Kigali, Rwanda
| | - Domina Asingizwe
- Department of Physiotherapy, School of Health Sciences, University of Rwanda, Kigali, Rwanda
- East African Community Regional Center of Excellence for Vaccines, Immunization and Health Supply Chain Management, Kigali, Rwanda
| | - Ahmed Adedeji
- Department of Pharmacy, School of Medicine and Pharmacy, University of Rwanda, Kigali, Rwanda
| | - Jean Baptiste Nyandwi
- Department of Pharmacy, School of Medicine and Pharmacy, University of Rwanda, Kigali, Rwanda
- East African Community Regional Center of Excellence for Vaccines, Immunization and Health Supply Chain Management, Kigali, Rwanda
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Ozodiegwu ID, Ogunwale AO, Surakat O, Akinyemi JO, Bamgboye EA, Fagbamigbe AF, Bello MM, Adamu AMY, Uhomobhi P, Ademu C, Okoronkwo C, Adeleke M, Ajayi IO. Description of the design of a mixed-methods study to assess the burden and determinants of malaria transmission for tailoring of interventions (microstratification) in Ibadan and Kano metropolis. Malar J 2023; 22:255. [PMID: 37661263 PMCID: PMC10476435 DOI: 10.1186/s12936-023-04684-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 08/22/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND Rapid urbanization in Nigerian cities may lead to localized variations in malaria transmission, particularly with a higher burden in informal settlements and slums. However, there is a lack of available data to quantify the variations in transmission risk at the city level and inform the selection of appropriate interventions. To bridge this gap, field studies will be undertaken in Ibadan and Kano, two major Nigerian cities. These studies will involve a blend of cross-sectional and longitudinal epidemiological research, coupled with longitudinal entomological studies. The primary objective is to gain insights into the variation of malaria risk at the smallest administrative units, known as wards, within these cities. METHODS/RESULTS The findings will contribute to the tailoring of interventions as part of Nigeria's National Malaria Strategic Plan. The study design incorporates a combination of model-based clustering and on-site visits for ground-truthing, enabling the identification of environmental archetypes at the ward-level to establish the study's framework. Furthermore, community participatory approaches will be utilized to refine study instruments and sampling strategies. The data gathered through cross-sectional and longitudinal studies will contribute to an enhanced understanding of malaria risk in the metropolises of Kano and Ibadan. CONCLUSIONS This paper outlines pioneering field study methods aimed at collecting data to inform the tailoring of malaria interventions in urban settings. The integration of multiple study types will provide valuable data for mapping malaria risk and comprehending the underlying determinants. Given the importance of location-specific data for microstratification, this study presents a systematic process and provides adaptable tools that can be employed in cities with limited data availability.
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Affiliation(s)
- Ifeoma D Ozodiegwu
- Department of Preventive Medicine and Institute for Global Health, Northwestern University, Chicago, IL, USA.
| | - Akintayo O Ogunwale
- Epidemiology and Biostatistics Research Unit, Institute for Advanced Medical Research and Training (IAMRAT), College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
- Department of Public Health, College of Health Sciences, Bowen University, Iwo, Osun, Nigeria
| | - Olabanji Surakat
- Department of Zoology, Osun State University, Osogbo, Osun, Nigeria
| | - Joshua O Akinyemi
- Epidemiology and Biostatistics Research Unit, Institute for Advanced Medical Research and Training (IAMRAT), College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - Eniola A Bamgboye
- Department of Preventive Medicine and Institute for Global Health, Northwestern University, Chicago, IL, USA
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - Adeniyi F Fagbamigbe
- Epidemiology and Biostatistics Research Unit, Institute for Advanced Medical Research and Training (IAMRAT), College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - Musa Muhammad Bello
- Epidemiology and Biostatistics Research Unit, Institute for Advanced Medical Research and Training (IAMRAT), College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
- Department of Community Medicine, Bayero University, Kano, Nigeria
| | - Al-Mukhtar Y Adamu
- Epidemiology and Biostatistics Research Unit, Institute for Advanced Medical Research and Training (IAMRAT), College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
- Department of Medical Microbiology and Parasitology, Bayero University, Kano, Nigeria
| | | | - Cyril Ademu
- National Malaria Elimination Programme, Abuja, Nigeria
| | | | - Monsuru Adeleke
- Department of Zoology, Osun State University, Osogbo, Osun, Nigeria.
| | - IkeOluwapo O Ajayi
- Epidemiology and Biostatistics Research Unit, Institute for Advanced Medical Research and Training (IAMRAT), College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria.
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria.
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Thawer SG, Golumbeanu M, Lazaro S, Chacky F, Munisi K, Aaron S, Molteni F, Lengeler C, Pothin E, Snow RW, Alegana VA. Spatio-temporal modelling of routine health facility data for malaria risk micro-stratification in mainland Tanzania. Sci Rep 2023; 13:10600. [PMID: 37391538 PMCID: PMC10313820 DOI: 10.1038/s41598-023-37669-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 06/26/2023] [Indexed: 07/02/2023] Open
Abstract
As malaria transmission declines, the need to monitor the heterogeneity of malaria risk at finer scales becomes critical to guide community-based targeted interventions. Although routine health facility (HF) data can provide epidemiological evidence at high spatial and temporal resolution, its incomplete nature of information can result in lower administrative units without empirical data. To overcome geographic sparsity of data and its representativeness, geo-spatial models can leverage routine information to predict risk in un-represented areas as well as estimate uncertainty of predictions. Here, a Bayesian spatio-temporal model was applied on malaria test positivity rate (TPR) data for the period 2017-2019 to predict risks at the ward level, the lowest decision-making unit in mainland Tanzania. To quantify the associated uncertainty, the probability of malaria TPR exceeding programmatic threshold was estimated. Results showed a marked spatial heterogeneity in malaria TPR across wards. 17.7 million people resided in areas where malaria TPR was high (≥ 30; 90% certainty) in the North-West and South-East parts of Tanzania. Approximately 11.7 million people lived in areas where malaria TPR was very low (< 5%; 90% certainty). HF data can be used to identify different epidemiological strata and guide malaria interventions at micro-planning units in Tanzania. These data, however, are imperfect in many settings in Africa and often require application of geo-spatial modelling techniques for estimation.
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Affiliation(s)
- Sumaiyya G Thawer
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland.
- University of Basel, Basel, Switzerland.
| | - Monica Golumbeanu
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Samwel Lazaro
- Ministry of Health, Dodoma, Tanzania
- National Malaria Control Programme, Dodoma, Tanzania
| | - Frank Chacky
- Ministry of Health, Dodoma, Tanzania
- National Malaria Control Programme, Dodoma, Tanzania
| | - Khalifa Munisi
- Ministry of Health, Dodoma, Tanzania
- National Malaria Control Programme, Dodoma, Tanzania
| | - Sijenunu Aaron
- Ministry of Health, Dodoma, Tanzania
- National Malaria Control Programme, Dodoma, Tanzania
| | - Fabrizio Molteni
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- National Malaria Control Programme, Dodoma, Tanzania
| | - Christian Lengeler
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Emilie Pothin
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- Clinton Health Access Initiative, New York, USA
| | - Robert W Snow
- Population Health Unit, KEMRI-Welcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Victor A Alegana
- World Health Organization, Regional Office for Africa, Brazzaville, Republic of Congo
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Epstein A, Namuganga JF, Nabende I, Kamya EV, Kamya MR, Dorsey G, Sturrock H, Bhatt S, Rodríguez-Barraquer I, Greenhouse B. Mapping malaria incidence using routine health facility surveillance data in Uganda. BMJ Glob Health 2023; 8:e011137. [PMID: 37208120 PMCID: PMC10201255 DOI: 10.1136/bmjgh-2022-011137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 04/11/2023] [Indexed: 05/21/2023] Open
Abstract
INTRODUCTION Maps of malaria risk are important tools for allocating resources and tracking progress. Most maps rely on cross-sectional surveys of parasite prevalence, but health facilities represent an underused and powerful data source. We aimed to model and map malaria incidence using health facility data in Uganda. METHODS Using 24 months (2019-2020) of individual-level outpatient data collected from 74 surveillance health facilities located in 41 districts across Uganda (n=445 648 laboratory-confirmed cases), we estimated monthly malaria incidence for parishes within facility catchment areas (n=310) by estimating care-seeking population denominators. We fit spatio-temporal models to the incidence estimates to predict incidence rates for the rest of Uganda, informed by environmental, sociodemographic and intervention variables. We mapped estimated malaria incidence and its uncertainty at the parish level and compared estimates to other metrics of malaria. To quantify the impact that indoor residual spraying (IRS) may have had, we modelled counterfactual scenarios of malaria incidence in the absence of IRS. RESULTS Over 4567 parish-months, malaria incidence averaged 705 cases per 1000 person-years. Maps indicated high burden in the north and northeast of Uganda, with lower incidence in the districts receiving IRS. District-level estimates of cases correlated with cases reported by the Ministry of Health (Spearman's r=0.68, p<0.0001), but were considerably higher (40 166 418 cases estimated compared with 27 707 794 cases reported), indicating the potential for underreporting by the routine surveillance system. Modelling of counterfactual scenarios suggest that approximately 6.2 million cases were averted due to IRS across the study period in the 14 districts receiving IRS (estimated population 8 381 223). CONCLUSION Outpatient information routinely collected by health systems can be a valuable source of data for mapping malaria burden. National Malaria Control Programmes may consider investing in robust surveillance systems within public health facilities as a low-cost, high benefit tool to identify vulnerable regions and track the impact of interventions.
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Affiliation(s)
- Adrienne Epstein
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Isaiah Nabende
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | - Moses R Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda
- Department of Medicine, Makerere University, Kampala, Uganda
| | - Grant Dorsey
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Hugh Sturrock
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
- Malaria Elimination Initiative, University of California San Francisco, San Francisco, California, USA
| | - Samir Bhatt
- Department of Public Health, University of Copenhagen, Kobenhavn, Denmark
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | | | - Bryan Greenhouse
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
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Ozodiegwu ID, Ambrose M, Galatas B, Runge M, Nandi A, Okuneye K, Dhanoa NP, Maikore I, Uhomoibhi P, Bever C, Noor A, Gerardin J. Application of mathematical modelling to inform national malaria intervention planning in Nigeria. Malar J 2023; 22:137. [PMID: 37101146 PMCID: PMC10130303 DOI: 10.1186/s12936-023-04563-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 04/15/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND For their 2021-2025 National Malaria Strategic Plan (NMSP), Nigeria's National Malaria Elimination Programme (NMEP), in partnership with the World Health Organization (WHO), developed a targeted approach to intervention deployment at the local government area (LGA) level as part of the High Burden to High Impact response. Mathematical models of malaria transmission were used to predict the impact of proposed intervention strategies on malaria burden. METHODS An agent-based model of Plasmodium falciparum transmission was used to simulate malaria morbidity and mortality in Nigeria's 774 LGAs under four possible intervention strategies from 2020 to 2030. The scenarios represented the previously implemented plan (business-as-usual), the NMSP at an 80% or higher coverage level and two prioritized plans according to the resources available to Nigeria. LGAs were clustered into 22 epidemiological archetypes using monthly rainfall, temperature suitability index, vector abundance, pre-2010 parasite prevalence, and pre-2010 vector control coverage. Routine incidence data were used to parameterize seasonality in each archetype. Each LGA's baseline malaria transmission intensity was calibrated to parasite prevalence in children under the age of five years measured in the 2010 Malaria Indicator Survey (MIS). Intervention coverage in the 2010-2019 period was obtained from the Demographic and Health Survey, MIS, the NMEP, and post-campaign surveys. RESULTS Pursuing a business-as-usual strategy was projected to result in a 5% and 9% increase in malaria incidence in 2025 and 2030 compared with 2020, while deaths were projected to remain unchanged by 2030. The greatest intervention impact was associated with the NMSP scenario with 80% or greater coverage of standard interventions coupled with intermittent preventive treatment in infants and extension of seasonal malaria chemoprevention (SMC) to 404 LGAs, compared to 80 LGAs in 2019. The budget-prioritized scenario with SMC expansion to 310 LGAs, high bed net coverage with new formulations, and increase in effective case management rate at the same pace as historical levels was adopted as an adequate alternative for the resources available. CONCLUSIONS Dynamical models can be applied for relative assessment of the impact of intervention scenarios but improved subnational data collection systems are required to allow increased confidence in predictions at sub-national level.
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Affiliation(s)
- Ifeoma D Ozodiegwu
- Department of Preventive Medicine and Institute for Global Health, Northwestern University, Chicago, IL, USA.
| | | | - Beatriz Galatas
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | - Manuela Runge
- Department of Preventive Medicine and Institute for Global Health, Northwestern University, Chicago, IL, USA
| | - Aadrita Nandi
- Department of Preventive Medicine and Institute for Global Health, Northwestern University, Chicago, IL, USA
| | - Kamaldeen Okuneye
- Department of Preventive Medicine and Institute for Global Health, Northwestern University, Chicago, IL, USA
| | - Neena Parveen Dhanoa
- Weinberg College of Arts and Sciences, Northwestern University, Evanston, IL, USA
| | - Ibrahim Maikore
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | | | | | - Abdisalan Noor
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | - Jaline Gerardin
- Department of Preventive Medicine and Institute for Global Health, Northwestern University, Chicago, IL, USA
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Moturi AK, Robert BN, Bahati F, Macharia PM, Okiro EA. Investigating rapid diagnostic testing in Kenya's health system, 2018-2020: validating non-reporting in routine data using a health facility service assessment survey. BMC Health Serv Res 2023; 23:306. [PMID: 36997953 PMCID: PMC10061357 DOI: 10.1186/s12913-023-09296-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 03/16/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Understanding the availability of rapid diagnostic tests (RDTs) is essential for attaining universal health care and reducing health inequalities. Although routine data helps measure RDT coverage and health access gaps, many healthcare facilities fail to report their monthly diagnostic test data to routine health systems, impacting routine data quality. This study sought to understand whether non-reporting by facilities is due to a lack of diagnostic and/or service provision capacity by triangulating routine and health service assessment survey data in Kenya. METHODS Routine facility-level data on RDT administration were sourced from the Kenya health information system for the years 2018-2020. Data on diagnostic capacity (RDT availability) and service provision (screening, diagnosis, and treatment) were obtained from a national health facility assessment conducted in 2018. The two sources were linked and compared obtaining information on 10 RDTs from both sources. The study then assessed reporting in the routine system among facilities with (i) diagnostic capacity only, (ii) both confirmed diagnostic capacity and service provision and (iii) without diagnostic capacity. Analyses were conducted nationally, disaggregated by RDT, facility level and ownership. RESULTS Twenty-one per cent (2821) of all facilities expected to report routine diagnostic data in Kenya were included in the triangulation. Most (86%) were primary-level facilities under public ownership (70%). Overall, survey response rates on diagnostic capacity were high (> 70%). Malaria and HIV had the highest response rate (> 96%) and the broadest coverage in diagnostic capacity across facilities (> 76%). Reporting among facilities with diagnostic capacity varied by test, with HIV and malaria having the lowest reporting rates, 58% and 52%, respectively, while the rest ranged between 69% and 85%. Among facilities with both service provision and diagnostic capacity, reporting ranged between 52% and 83% across tests. Public and secondary facilities had the highest reporting rates across all tests. A small proportion of health facilities without diagnostic capacity submitted testing reports in 2018, most of which were primary facilities. CONCLUSION Non-reporting in routine health systems is not always due to a lack of capacity. Further analyses are required to inform other drivers of non-reporting to ensure reliable routine health data.
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Affiliation(s)
- Angela K Moturi
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Bibian N Robert
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Felix Bahati
- Health Services Research Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Peter M Macharia
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Health Informatics, Computing, and Statistics, Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Emelda A Okiro
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Ashton RA, Hamainza B, Lungu C, Rutagwera MRI, Porter T, Bennett A, Hainsworth M, Burnett S, Silumbe K, Slater H, Eisele TP, Miller JM. Effectiveness of community case management of malaria on severe malaria and inpatient malaria deaths in Zambia: a dose-response study using routine health information system data. Malar J 2023; 22:96. [PMID: 36927440 PMCID: PMC10022244 DOI: 10.1186/s12936-023-04525-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 03/07/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Community case management of malaria (CCM) has been expanded in many settings, but there are limited data describing the impact of these services in routine implementation settings or at large scale. Zambia has intensively expanded CCM since 2013, whereby trained volunteer community health workers (CHW) use rapid diagnostic tests and artemether-lumefantrine to diagnose and treat uncomplicated malaria. METHODS This retrospective, observational study explored associations between changing malaria service point (health facility or CHW) density per 1000 people and severe malaria admissions or malaria inpatient deaths by district and month in a dose-response approach, using existing routine and programmatic data. Negative binomial generalized linear mixed-effect models were used to assess the impact of increasing one additional malaria service point per 1000 population, and of achieving Zambia's interim target of 1 service point per 750 population. Access to insecticide-treated nets, indoor-residual spraying, and rainfall anomaly were included in models to reduce potential confounding. RESULTS The study captured 310,855 malaria admissions and 7158 inpatient malaria deaths over 83 districts (seven provinces) from January 2015 to May 2020. Total CHWs increased from 43 to 4503 during the study period, while health facilities increased from 1263 to 1765. After accounting for covariates, an increase of one malaria service point per 1000 was associated with a 19% reduction in severe malaria admissions among children under five (incidence rate ratio [IRR] 0.81, 95% confidence interval [CI] 0.75-0.87, p < 0.001) and 23% reduction in malaria deaths among under-fives (IRR 0.77, 95% CI 0.66-0.91). After categorizing the exposure of population per malaria service point, there was evidence for an effect on malaria admissions and inpatient malaria deaths among children under five only when reaching the target of one malaria service point per 750 population. CONCLUSIONS CCM is an effective strategy for preventing severe malaria and deaths in areas such as Zambia where malaria diagnosis and treatment access remains challenging. These results support the continued investment in CCM scale-up in similar settings, to improve access to malaria diagnosis and treatment.
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Affiliation(s)
- Ruth A Ashton
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2300, New Orleans, LA, USA.
| | - Busiku Hamainza
- National Malaria Elimination Centre, Zambia Ministry of Health, Lusaka, Zambia
| | - Chris Lungu
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Lusaka, Zambia
| | | | - Travis Porter
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2300, New Orleans, LA, USA
| | | | | | | | - Kafula Silumbe
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Lusaka, Zambia
| | | | - Thomas P Eisele
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2300, New Orleans, LA, USA
| | - John M Miller
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Lusaka, Zambia
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11
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Macharia PM, Joseph NK, Nalwadda GK, Mwilike B, Banke-Thomas A, Benova L, Johnson O. Spatial variation and inequities in antenatal care coverage in Kenya, Uganda and mainland Tanzania using model-based geostatistics: a socioeconomic and geographical accessibility lens. BMC Pregnancy Childbirth 2022; 22:908. [PMID: 36474193 PMCID: PMC9724345 DOI: 10.1186/s12884-022-05238-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Pregnant women in sub-Saharan Africa (SSA) experience the highest levels of maternal mortality and stillbirths due to predominantly avoidable causes. Antenatal care (ANC) can prevent, detect, alleviate, or manage these causes. While eight ANC contacts are now recommended, coverage of the previous minimum of four visits (ANC4+) remains low and inequitable in SSA. METHODS We modelled ANC4+ coverage and likelihood of attaining district-level target coverage of 70% across three equity stratifiers (household wealth, maternal education, and travel time to the nearest health facility) based on data from malaria indicator surveys in Kenya (2020), Uganda (2018/19) and Tanzania (2017). Geostatistical models were fitted to predict ANC4+ coverage and compute exceedance probability for target coverage. The number of pregnant women without ANC4+ were computed. Prediction was at 3 km spatial resolution and aggregated at national and district -level for sub-national planning. RESULTS About six in ten women reported ANC4+ visits, meaning that approximately 3 million women in the three countries had <ANC4+ visits. The majority of the 366 districts in the three countries had ANC4+ coverage of 50-70%. In Kenya, 13% of districts had < 70% coverage, compared to 10% and 27% of the districts in Uganda and mainland Tanzania, respectively. Only one district in Kenya and ten districts in mainland Tanzania were likely met the target coverage. Six percent, 38%, and 50% of the districts had at most 5000 women with <ANC4+ visits in Kenya, Uganda, and mainland Tanzania, respectively, while districts with > 20,000 women having <ANC4+ visits were 38%, 1% and 1%, respectively. In many districts, ANC4+ coverage and likelihood of attaining the target coverage was lower among the poor, uneducated and those geographically marginalized from healthcare. CONCLUSIONS These findings will be invaluable to policymakers for annual appropriations of resources as part of efforts to reduce maternal deaths and stillbirths.
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Affiliation(s)
- Peter M. Macharia
- grid.33058.3d0000 0001 0155 5938Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya ,grid.9835.70000 0000 8190 6402Centre for Health Informatics, Computing, and Statistics, Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Noel K. Joseph
- grid.33058.3d0000 0001 0155 5938Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya ,grid.9835.70000 0000 8190 6402Centre for Health Informatics, Computing, and Statistics, Lancaster Medical School, Lancaster University, Lancaster, UK
| | | | - Beatrice Mwilike
- grid.25867.3e0000 0001 1481 7466Community Health Nursing Department, School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Aduragbemi Banke-Thomas
- grid.36316.310000 0001 0806 5472School of Human Sciences, University of Greenwich, London, UK
| | - Lenka Benova
- grid.11505.300000 0001 2153 5088Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Olatunji Johnson
- grid.5379.80000000121662407Department of Mathematics, The University of Manchester, Manchester, UK
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12
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The use of routine health facility data for micro-stratification of malaria risk in mainland Tanzania. Malar J 2022; 21:345. [DOI: 10.1186/s12936-022-04364-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/05/2022] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background
Current efforts to estimate the spatially diverse malaria burden in malaria-endemic countries largely involve the use of epidemiological modelling methods for describing temporal and spatial heterogeneity using sparse interpolated prevalence data from periodic cross-sectional surveys. However, more malaria-endemic countries are beginning to consider local routine data for this purpose. Nevertheless, routine information from health facilities (HFs) remains widely under-utilized despite improved data quality, including increased access to diagnostic testing and the adoption of the electronic District Health Information System (DHIS2). This paper describes the process undertaken in mainland Tanzania using routine data to develop a high-resolution, micro-stratification risk map to guide future malaria control efforts.
Methods
Combinations of various routine malariometric indicators collected from 7098 HFs were assembled across 3065 wards of mainland Tanzania for the period 2017–2019. The reported council-level prevalence classification in school children aged 5–16 years (PfPR5–16) was used as a benchmark to define four malaria risk groups. These groups were subsequently used to derive cut-offs for the routine indicators by minimizing misclassifications and maximizing overall agreement. The derived-cutoffs were converted into numbered scores and summed across the three indicators to allocate wards into their overall risk stratum.
Results
Of 3065 wards, 353 were assigned to the very low strata (10.5% of the total ward population), 717 to the low strata (28.6% of the population), 525 to the moderate strata (16.2% of the population), and 1470 to the high strata (39.8% of the population). The resulting micro-stratification revealed malaria risk heterogeneity within 80 councils and identified wards that would benefit from community-level focal interventions, such as community-case management, indoor residual spraying and larviciding.
Conclusion
The micro-stratification approach employed is simple and pragmatic, with potential to be easily adopted by the malaria programme in Tanzania. It makes use of available routine data that are rich in spatial resolution and that can be readily accessed allowing for a stratification of malaria risk below the council level. Such a framework is optimal for supporting evidence-based, decentralized malaria control planning, thereby improving the effectiveness and allocation efficiency of malaria control interventions.
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Mohammed K, Salifu MG, Batung E, Amoak D, Avoka VA, Kansanga M, Luginaah I. Spatial analysis of climatic factors and plasmodium falciparum malaria prevalence among children in Ghana. Spat Spatiotemporal Epidemiol 2022; 43:100537. [PMID: 36460447 DOI: 10.1016/j.sste.2022.100537] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 06/16/2022] [Accepted: 09/13/2022] [Indexed: 12/15/2022]
Abstract
Malaria is a major public health problem especially in Africa where 94% of global malaria cases occur. Malaria prevalence and mortalities are disproportionately higher among children. In 2019, children accounted for 67% of malaria deaths globally. Recently, climatic factors have been acknowledged to influence the number and severity of malaria cases. Plasmodium falciparum-the most deadly malaria parasite, accounts for more than 95% of malaria infections among children in Ghana. Using the 2017 Ghana Demographic Health Survey data, we examined the local variation in the prevalence and climatic determinants of child malaria. The findings showed that climatic factors such as temperature, rainfall aridity and Enhanced Vegetation Index are significantly and positively associated with Plasmodium falciparum malaria prevalence among children in Ghana. However, there are local variations in how these climatic factors affect child malaria prevalence. Plasmodium falciparum malaria prevalence was highest among children in the south western, north western and northern Ghana.
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Affiliation(s)
- Kamaldeen Mohammed
- Department of Geography and Environment, University of Western Ontario, 151 Richmond St, London, Ontario, Canada.
| | | | - Evans Batung
- Department of Geography and Environment, University of Western Ontario, 151 Richmond St, London, Ontario, Canada
| | - Daniel Amoak
- Department of Geography and Environment, University of Western Ontario, 151 Richmond St, London, Ontario, Canada
| | | | - Moses Kansanga
- Department of Geography, George Washington University, 2121 I St NW, Washington, DC 20052, USA
| | - Isaac Luginaah
- Department of Geography and Environment, University of Western Ontario, 151 Richmond St, London, Ontario, Canada
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14
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Kayange M, M'baya B, Hwandih T, Saker J, Coetzer TL, Münster M. Automated measurement of malaria parasitaemia among asymptomatic blood donors in Malawi using the Sysmex XN-31 analyser: could such data be used to complement national malaria surveillance in real time? Malar J 2022; 21:299. [PMID: 36284305 DOI: 10.1186/s12936-022-04314-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The recent worldwide increase in malaria cases highlights the need for renewed efforts to eliminate malaria. The World Health Organization advocates that malaria surveillance becomes a core intervention. Current methods to estimate the malaria burden rely on clinical malaria case reports and surveys of asymptomatic parasite infection mainly from children < 5 years. In this study the hypothesis was that screening blood donors for malaria parasites would provide real-time information on the asymptomatic reservoir of parasites in the adult population and mirror other surveillance data. METHODS This study was conducted in Malawi, a high malaria burden country, at the Malawi Blood Transfusion Service, which collects blood units at donation sites countrywide. A secondary analysis was conducted on data obtained from a prior Sysmex XN-31 analyser malaria diagnostic evaluation study utilizing residual donor blood samples. XN-31 malaria results, donor age, sex, geographical location, and collection date, were analysed using standard statistical methods. RESULTS The malaria parasite prevalence in blood donors was 11.6% (614/5281 samples) increasing seasonally from December (8.6%) to April (18.3%). The median age was 21 years and 45.9% of donors were from urban areas, which showed a lower prevalence compared to non-urban regions. The Central administrative region had the highest and the Northern region the lowest malaria parasite prevalence. The donors were predominantly male (80.2%), 13.1% of whom had malaria parasites, which was significantly higher (p < 0.0001) than for female donors (7.4%). Multivariable logistic regression analysis showed that age, location, and collection month were significant predictors of malaria positivity in males, whereas in females only location was significant. There was no gender difference in parasite density nor gametocyte carriage. CONCLUSIONS This study demonstrates the powerful utility of screening blood donors for malaria parasites using the XN-31, which not only improves the safety of blood transfusion, but provides valuable complementary surveillance data for malaria control, especially targeting males, who are generally excluded from periodic household surveys. Blood donations are sourced countrywide, year-round, and thus provide dynamic, real-time information on the malaria burden. Furthermore, the XN-31 identifies the asymptomatic human reservoir of infectious gametocytes, which must be targeted to eliminate malaria.
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Affiliation(s)
- Michael Kayange
- National Malaria Control Programme, Ministry of Health, Lilongwe, Malawi
| | | | - Talent Hwandih
- Sysmex Europe SE, Bornbarch 1, 22848, Norderstedt, Germany
| | - Jarob Saker
- Sysmex Europe SE, Bornbarch 1, 22848, Norderstedt, Germany
| | - Thérèsa L Coetzer
- Sysmex Europe SE, Bornbarch 1, 22848, Norderstedt, Germany.,Faculty of Health Sciences, Wits Research Institute for Malaria, University of the Witwatersrand, Johannesburg, South Africa
| | - Marion Münster
- Sysmex Europe SE, Bornbarch 1, 22848, Norderstedt, Germany.
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15
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Macharia PM, Ray N, Gitonga CW, Snow RW, Giorgi E. Combining school-catchment area models with geostatistical models for analysing school survey data from low-resource settings: Inferential benefits and limitations. SPATIAL STATISTICS 2022; 51:100679. [PMID: 35880005 PMCID: PMC7613137 DOI: 10.1016/j.spasta.2022.100679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
School-based sampling has been used to inform targeted responses for malaria and neglected tropical diseases. Standard geostatistical methods for mapping disease prevalence use the school location to model spatial correlation, which is questionable since exposure to the disease is more likely to occur in the residential location. In this paper, we propose to overcome the limitations of standard geostatistical methods by introducing a modelling framework that accounts for the uncertainty in the location of the residence of the students. By using cost distance and cost allocation models to define spatial accessibility and in absence of any information on the travel mode of students to school, we consider three school catchment area models that assume walking only, walking and bicycling and, walking and motorized transport. We illustrate the use of this approach using two case studies of malaria in Kenya and compare it with the standard approach that uses the school locations to build geostatistical models. We argue that the proposed modelling framework presents several inferential benefits, such as the ability to combine data from multiple surveys some of which may also record the residence location, and to deal with ecological bias when estimating the effects of malaria risk factors. However, our results show that invalid assumptions on the modes of travel to school can worsen the predictive performance of geostatistical models. Future research in this area should focus on collecting information on the modes of transportation to school which can then be used to better parametrize the catchment area models.
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Affiliation(s)
- Peter M. Macharia
- Centre for Health Informatics, Computing, and Statistics, Lancaster Medical School, Lancaster University, Lancaster, LA1 4YW, UK
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, PO, Box 43640, Nairobi, Kenya
| | - Nicolas Ray
- GeoHealth group, Institute of Global Health, University of Geneva, Geneva, Switzerland
- Institute for Environmental Sciences, University of Geneva, Geneva, Switzerland
| | - Caroline W. Gitonga
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, PO, Box 43640, Nairobi, Kenya
| | - Robert W. Snow
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, PO, Box 43640, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7LG, UK
| | - Emanuele Giorgi
- Centre for Health Informatics, Computing, and Statistics, Lancaster Medical School, Lancaster University, Lancaster, LA1 4YW, UK
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16
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Inferring the epidemiological benefit of indoor vector control interventions against malaria from mosquito data. Nat Commun 2022; 13:3862. [PMID: 35790746 PMCID: PMC9256631 DOI: 10.1038/s41467-022-30700-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/11/2022] [Indexed: 12/03/2022] Open
Abstract
The cause of malaria transmission has been known for over a century but it is still unclear whether entomological measures are sufficiently reliable to inform policy decisions in human health. Decision-making on the effectiveness of new insecticide-treated nets (ITNs) and the indoor residual spraying of insecticide (IRS) have been based on epidemiological data, typically collected in cluster-randomised control trials. The number of these trials that can be conducted is limited. Here we use a systematic review to highlight that efficacy estimates of the same intervention may vary substantially between trials. Analyses indicate that mosquito data collected in experimental hut trials can be used to parameterize mechanistic models for Plasmodium falciparum malaria and reliably predict the epidemiological efficacy of quick-acting, neuro-acting ITNs and IRS. Results suggest that for certain types of ITNs and IRS using this framework instead of clinical endpoints could support policy and expedite the widespread use of novel technologies. Estimating the effectiveness of malaria vector control interventions has typically relied on resource-intensive cluster randomised trials. Here, the authors estimate changes in malaria prevalence using entomological data from experimental hut trials, which may provide an alternative route to approval of interventions in some situations.
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17
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Malaria Threatens to Bounce Back in Abergele District, Northeast Ethiopia: Five-Year Retrospective Trend Analysis from 2016-2020 in Nirak Health Center. BIOMED RESEARCH INTERNATIONAL 2022; 2022:6388979. [PMID: 35711525 PMCID: PMC9197627 DOI: 10.1155/2022/6388979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/21/2022] [Accepted: 05/20/2022] [Indexed: 11/18/2022]
Abstract
Background In Sub-Saharan African countries, malaria is a leading cause of morbidity and mortality. In Ethiopia, malaria is found in three-fourths of its land mass with more than 63 million people living in malaria endemic areas. Nowadays, Ethiopia is implementing a malaria elimination program with the goal of eliminating the disease by 2030. To assist this goal, the trends of malaria cases should be evaluated with a function of time in different areas of the country to develop area-specific evidence-based interventions. Therefore, this study was aimed at analysing a five year trend of malaria in Nirak Health Center, Abergele District, Northeast Ethiopia, from 2016 to 2020. Methods A retrospective study was conducted at Nirak Health Center, Abergele District, Northeast Ethiopia from February to April 2021. Five-year (2016 to 2020) retrospective data were reviewed from the malaria registration laboratory logbook. The sociodemographic and malaria data were collected using a predesigned data collection sheet. Data were entered, cleaned, and analysed using SPSS version 26. Results In the five-year period, a total of 19,433 malaria suspected patients were diagnosed by microscopic examination. Of these, 6,473 (33.3%) were positive for malaria parasites. Of the total confirmed cases, 5,900 (91.2%) were P. falciparum and 474 (7.2%) were P. vivax. Majority of the cases were males (62.2%) and in the age group of 15-45 years old (52.8%). The findings of this study showed an increasing trend in malaria cases in the past five years (2016-2020). The maximum number of confirmed malaria cases reported was in the year 2020, while the minimum number of confirmed malaria cases registered was in 2016. Regarding the seasonal distribution of malaria, the highest number of malaria cases (55.2%) was observed in Dry season (September to January) and also the least (15.9%) was observed in Autumn (March to May) replaced by the least (21.6%) was observed in Rainy season (June to August), that is, the major malaria transmission season in Ethiopia and the least (15.9%) was observed in autumn (March to May). Conclusion The trends of malaria in Nirak Health Center showed steadily increasing from the year 2016–2020, and the predominant species isolated was P. falciparum. This showed that the malaria control and elimination strategy in the area were not properly implemented or failed to achieve its designed goal. Therefore, this finding alarms the local governments and other stack holders urgently to revise their intervention strategies and take action in the locality.
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18
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de Cola MA, Sawadogo B, Richardson S, Ibinaiye T, Traoré A, Compaoré CS, Oguoma C, Oresanya O, Tougri G, Rassi C, Roca-Feltrer A, Walker P, Okell LC. Impact of seasonal malaria chemoprevention on prevalence of malaria infection in malaria indicator surveys in Burkina Faso and Nigeria. BMJ Glob Health 2022; 7:bmjgh-2021-008021. [PMID: 35589153 PMCID: PMC9121431 DOI: 10.1136/bmjgh-2021-008021] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 04/13/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND In 2012, the WHO issued a policy recommendation for the use of seasonal malaria chemoprevention (SMC) to children 3-59 months in areas of highly seasonal malaria transmission. Clinical trials have found SMC to prevent around 75% of clinical malaria. Impact under routine programmatic conditions has been assessed during research studies but there is a need to identify sustainable methods to monitor impact using routinely collected data. METHODS Data from Demographic Health Surveys were merged with rainfall, geographical and programme data in Burkina Faso (2010, 2014, 2017) and Nigeria (2010, 2015, 2018) to assess impact of SMC. We conducted mixed-effects logistic regression to predict presence of malaria infection in children aged 6-59 months (rapid diagnostic test (RDT) and microscopy, separately). RESULTS We found strong evidence that SMC administration decreases odds of malaria measured by RDT during SMC programmes, after controlling for seasonal factors, age, sex, net use and other variables (Burkina Faso OR 0.28, 95% CI 0.21 to 0.37, p<0.001; Nigeria OR 0.40, 95% CI 0.30 to 0.55, p<0.001). The odds of malaria were lower up to 2 months post-SMC in Burkina Faso (1-month post-SMC: OR 0.29, 95% CI 0.12 to 0.72, p=0.01; 2 months post-SMC: OR: 0.33, 95% CI 0.17 to 0.64, p<0.001). The odds of malaria were lower up to 1 month post-SMC in Nigeria but was not statistically significant (1-month post-SMC 0.49, 95% CI 0.23 to 1.05, p=0.07). A similar but weaker effect was seen for microscopy (Burkina Faso OR 0.38, 95% CI 0.29 to 0.52, p<0.001; Nigeria OR 0.53, 95% CI 0.38 to 0.76, p<0.001). CONCLUSIONS Impact of SMC can be detected in reduced prevalence of malaria from data collected through household surveys if conducted during SMC administration or within 2 months afterwards. Such evidence could contribute to broader evaluation of impact of SMC programmes.
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Affiliation(s)
- Monica Anna de Cola
- Department of Infectious Disease Epidemiology, Imperial College, London, UK,Malaria Consortium, London, UK
| | | | - Sol Richardson
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | | | | | | | | | | | | | | | | | - Patrick Walker
- Department of Infectious Disease Epidemiology, Imperial College, London, UK
| | - Lucy C Okell
- Department of Infectious Disease Epidemiology, Imperial College, London, UK
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19
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Muchiri SK, Muthee R, Kiarie H, Sitienei J, Agweyu A, Atkinson PM, Edson Utazi C, Tatem AJ, Alegana VA. Unmet need for COVID-19 vaccination coverage in Kenya. Vaccine 2022; 40:2011-2019. [PMID: 35184925 PMCID: PMC8841160 DOI: 10.1016/j.vaccine.2022.02.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/30/2022] [Accepted: 02/07/2022] [Indexed: 11/30/2022]
Abstract
COVID-19 has impacted the health and livelihoods of billions of people since it emerged in 2019. Vaccination for COVID-19 is a critical intervention that is being rolled out globally to end the pandemic. Understanding the spatial inequalities in vaccination coverage and access to vaccination centres is important for planning this intervention nationally. Here, COVID-19 vaccination data, representing the number of people given at least one dose of vaccine, a list of the approved vaccination sites, population data and ancillary GIS data were used to assess vaccination coverage, using Kenya as an example. Firstly, physical access was modelled using travel time to estimate the proportion of population within 1 hour of a vaccination site. Secondly, a Bayesian conditional autoregressive (CAR) model was used to estimate the COVID-19 vaccination coverage and the same framework used to forecast coverage rates for the first quarter of 2022. Nationally, the average travel time to a designated COVID-19 vaccination site (n = 622) was 75.5 min (Range: 62.9 - 94.5 min) and over 87% of the population >18 years reside within 1 hour to a vaccination site. The COVID-19 vaccination coverage in December 2021 was 16.70% (95% CI: 16.66 - 16.74) - 4.4 million people and was forecasted to be 30.75% (95% CI: 25.04 - 36.96) - 8.1 million people by the end of March 2022. Approximately 21 million adults were still unvaccinated in December 2021 and, in the absence of accelerated vaccine uptake, over 17.2 million adults may not be vaccinated by end March 2022 nationally. Our results highlight geographic inequalities at sub-national level and are important in targeting and improving vaccination coverage in hard-to-reach populations. Similar mapping efforts could help other countries identify and increase vaccination coverage for such populations.
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Affiliation(s)
- Samuel K Muchiri
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya.
| | - Rose Muthee
- Department of Health Informatics, Monitoring and Evaluation, Ministry of Health, Nairobi, Kenya
| | - Hellen Kiarie
- Department of Health Informatics, Monitoring and Evaluation, Ministry of Health, Nairobi, Kenya
| | - Joseph Sitienei
- Department of Health Informatics, Monitoring and Evaluation, Ministry of Health, Nairobi, Kenya
| | - Ambrose Agweyu
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme Nairobi, Kenya
| | - Peter M Atkinson
- Lancaster Environment Centre, Lancaster University, Lancaster LA1 4YQ, UK; Geography and Environmental Science, University of Southampton, Highfield, Southampton SO17 1BJ, UK; Institute of Geographic Sciences and Natural Resource Research, Chinese Academy of Sciences, Beijing 100101, China
| | - C Edson Utazi
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, UK; Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, UK
| | - Andrew J Tatem
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, UK
| | - Victor A Alegana
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya; Geography and Environmental Science, University of Southampton, Highfield, Southampton SO17 1BJ, UK
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Oguike OE, Ugwuishiwu CH, Asogwa CN, Nnadi CO, Obonga WO, Attama AA. Systematic review on the application of machine learning to quantitative structure-activity relationship modeling against Plasmodium falciparum. Mol Divers 2022; 26:3447-3462. [PMID: 35064444 PMCID: PMC8782692 DOI: 10.1007/s11030-022-10380-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/07/2022] [Indexed: 11/29/2022]
Abstract
Malaria accounts for over two million deaths globally. To flatten this curve, there is a need to develop new and high potent drugs against Plasmodium falciparum. Some major challenges include the dearth of suitable animal models for anti-P. falciparum assays, resistance to first-line drugs, lack of vaccines and the complex life cycle of Plasmodium. Gladly, newer approaches to antimalarial drug discovery have emerged due to the release of large datasets by pharmaceutical companies. This review provides insights into these new approaches to drug discovery covering different machine learning tools, which enhance the development of new compounds. It provides a systematic review on the use and prospects of machine learning in predicting, classifying and clustering IC50 values of bioactive compounds against P. falciparum. The authors identified many machine learning tools yet to be applied for this purpose. However, Random Forest and Support Vector Machines have been extensively applied though on a limited dataset of compounds.
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Affiliation(s)
- Osondu Everestus Oguike
- Machine Learning Research Group, University of Nigeria, Nsukka, 410001, Enugu State, Nigeria.,Department of Computer Science, Faculty of Physical Sciences, University of Nigeria, Nsukka, 410001, Enugu State, Nigeria
| | - Chikodili Helen Ugwuishiwu
- Machine Learning Research Group, University of Nigeria, Nsukka, 410001, Enugu State, Nigeria.,Department of Computer Science, Faculty of Physical Sciences, University of Nigeria, Nsukka, 410001, Enugu State, Nigeria
| | - Caroline Ngozi Asogwa
- Machine Learning Research Group, University of Nigeria, Nsukka, 410001, Enugu State, Nigeria.,Department of Computer Science, Faculty of Physical Sciences, University of Nigeria, Nsukka, 410001, Enugu State, Nigeria
| | - Charles Okeke Nnadi
- Machine Learning Research Group, University of Nigeria, Nsukka, 410001, Enugu State, Nigeria. .,Deprtment of Pharmaceutical and Medicinal Chemistry, Faculty of Pharmaceutical Sciences, University of Nigeria, Nsukka, 410001, Enugu State, Nigeria.
| | - Wilfred Ofem Obonga
- Machine Learning Research Group, University of Nigeria, Nsukka, 410001, Enugu State, Nigeria.,Deprtment of Pharmaceutical and Medicinal Chemistry, Faculty of Pharmaceutical Sciences, University of Nigeria, Nsukka, 410001, Enugu State, Nigeria
| | - Anthony Amaechi Attama
- Machine Learning Research Group, University of Nigeria, Nsukka, 410001, Enugu State, Nigeria.,Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, University of Nigeria, Nsukka, 410001, Enugu State, Nigeria
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21
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Epstein A, Maiteki-Sebuguzi C, Namuganga JF, Nankabirwa JI, Gonahasa S, Opigo J, Staedke SG, Rutazaana D, Arinaitwe E, Kamya MR, Bhatt S, Rodríguez-Barraquer I, Greenhouse B, Donnelly MJ, Dorsey G. Resurgence of malaria in Uganda despite sustained indoor residual spraying and repeated long lasting insecticidal net distributions. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000676. [PMID: 36962736 PMCID: PMC10022262 DOI: 10.1371/journal.pgph.0000676] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 07/27/2022] [Indexed: 11/19/2022]
Abstract
Five years of sustained indoor residual spraying (IRS) of insecticide from 2014 to 2019, first using a carbamate followed by an organophosphate, was associated with a marked reduction in the incidence of malaria in five districts of Uganda. We assessed changes in malaria incidence over an additional 21 months, corresponding to a change in IRS formulations using clothianidin with and without deltamethrin. Using enhanced health facility surveillance data, our objectives were to 1) estimate the impact of IRS on monthly malaria case counts at five surveillance sites over a 6.75 year period, and 2) compare monthly case counts at five facilities receiving IRS to ten facilities in neighboring districts not receiving IRS. For both objectives, we specified mixed effects negative binomial regression models with random intercepts for surveillance site adjusting for rainfall, season, care-seeking, and malaria diagnostic. Following the implementation of IRS, cases were 84% lower in years 4-5 (adjusted incidence rate ratio [aIRR] = 0.16, 95% CI 0.12-0.22), 43% lower in year 6 (aIRR = 0.57, 95% CI 0.44-0.74), and 39% higher in the first 9 months of year 7 (aIRR = 1.39, 95% CI 0.97-1.97) compared to pre-IRS levels. Cases were 67% lower in IRS sites than non-IRS sites in year 6 (aIRR = 0.33, 95% CI 0.17-0.63) but 38% higher in the first 9 months of year 7 (aIRR = 1.38, 95% CI 0.90-2.11). We observed a resurgence in malaria to pre-IRS levels despite sustained IRS. The timing of this resurgence corresponded to a change of active ingredient. Further research is needed to determine causality.
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Affiliation(s)
- Adrienne Epstein
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| | | | | | - Joaniter I Nankabirwa
- Infectious Diseases Research Collaboration, Kampala, Uganda
- College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Jimmy Opigo
- National Malaria Control Division, Ministry of Health, Kampala, Uganda
| | - Sarah G Staedke
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Damian Rutazaana
- National Malaria Control Division, Ministry of Health, Kampala, Uganda
| | | | - Moses R Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Samir Bhatt
- Department of Infectious Disease Epidemiology, Imperial College, St Mary's Hospital, London, United Kingdom
- Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - Isabel Rodríguez-Barraquer
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Bryan Greenhouse
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Martin J Donnelly
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Grant Dorsey
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
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22
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Alegana VA, Macharia PM, Muchiri S, Mumo E, Oyugi E, Kamau A, Chacky F, Thawer S, Molteni F, Rutazanna D, Maiteki-Sebuguzi C, Gonahasa S, Noor AM, Snow RW. Plasmodium falciparum parasite prevalence in East Africa: Updating data for malaria stratification. PLOS GLOBAL PUBLIC HEALTH 2021; 1:e0000014. [PMID: 35211700 PMCID: PMC7612417 DOI: 10.1371/journal.pgph.0000014] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 11/15/2021] [Indexed: 11/18/2022]
Abstract
The High Burden High Impact (HBHI) strategy for malaria encourages countries to use multiple sources of available data to define the sub-national vulnerabilities to malaria risk, including parasite prevalence. Here, a modelled estimate of Plasmodium falciparum from an updated assembly of community parasite survey data in Kenya, mainland Tanzania, and Uganda is presented and used to provide a more contemporary understanding of the sub-national malaria prevalence stratification across the sub-region for 2019. Malaria prevalence data from surveys undertaken between January 2010 and June 2020 were assembled form each of the three countries. Bayesian spatiotemporal model-based approaches were used to interpolate space-time data at fine spatial resolution adjusting for population, environmental and ecological covariates across the three countries. A total of 18,940 time-space age-standardised and microscopy-converted surveys were assembled of which 14,170 (74.8%) were identified after 2017. The estimated national population-adjusted posterior mean parasite prevalence was 4.7% (95% Bayesian Credible Interval 2.6-36.9) in Kenya, 10.6% (3.4-39.2) in mainland Tanzania, and 9.5% (4.0-48.3) in Uganda. In 2019, more than 12.7 million people resided in communities where parasite prevalence was predicted ≥ 30%, including 6.4%, 12.1% and 6.3% of Kenya, mainland Tanzania and Uganda populations, respectively. Conversely, areas that supported very low parasite prevalence (<1%) were inhabited by approximately 46.2 million people across the sub-region, or 52.2%, 26.7% and 10.4% of Kenya, mainland Tanzania and Uganda populations, respectively. In conclusion, parasite prevalence represents one of several data metrics for disease stratification at national and sub-national levels. To increase the use of this metric for decision making, there is a need to integrate other data layers on mortality related to malaria, malaria vector composition, insecticide resistance and bionomic, malaria care-seeking behaviour and current levels of unmet need of malaria interventions.
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Affiliation(s)
- Victor A. Alegana
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
- Geography and Environmental Science, University of Southampton, Southampton, United Kingdom
| | - Peter M. Macharia
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Health Informatics, Computing, and Statistics, Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
| | - Samuel Muchiri
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Eda Mumo
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Elvis Oyugi
- Division of National Malaria Programme, Ministry of Health, Nairobi, Kenya
| | - Alice Kamau
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Frank Chacky
- National Malaria Control Programme, Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Sumaiyya Thawer
- National Malaria Control Programme, Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Fabrizio Molteni
- National Malaria Control Programme, Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Damian Rutazanna
- National Malaria Control Division, Ministry of Health, Kampala, Uganda
| | - Catherine Maiteki-Sebuguzi
- National Malaria Control Division, Ministry of Health, Kampala, Uganda
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | - Abdisalan M. Noor
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Robert W. Snow
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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23
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Odhiambo JN, Kalinda C, Macharia PM, Snow RW, Sartorius B. Spatial and spatio-temporal methods for mapping malaria risk: a systematic review. BMJ Glob Health 2021; 5:bmjgh-2020-002919. [PMID: 33023880 PMCID: PMC7537142 DOI: 10.1136/bmjgh-2020-002919] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 08/23/2020] [Accepted: 08/24/2020] [Indexed: 12/21/2022] Open
Abstract
Background Approaches in malaria risk mapping continue to advance in scope with the advent of geostatistical techniques spanning both the spatial and temporal domains. A substantive review of the merits of the methods and covariates used to map malaria risk has not been undertaken. Therefore, this review aimed to systematically retrieve, summarise methods and examine covariates that have been used for mapping malaria risk in sub-Saharan Africa (SSA). Methods A systematic search of malaria risk mapping studies was conducted using PubMed, EBSCOhost, Web of Science and Scopus databases. The search was restricted to refereed studies published in English from January 1968 to April 2020. To ensure completeness, a manual search through the reference lists of selected studies was also undertaken. Two independent reviewers completed each of the review phases namely: identification of relevant studies based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, data extraction and methodological quality assessment using a validated scoring criterion. Results One hundred and seven studies met the inclusion criteria. The median quality score across studies was 12/16 (range: 7–16). Approximately half (44%) of the studies employed variable selection techniques prior to mapping with rainfall and temperature selected in over 50% of the studies. Malaria incidence (47%) and prevalence (35%) were the most commonly mapped outcomes, with Bayesian geostatistical models often (31%) the preferred approach to risk mapping. Additionally, 29% of the studies employed various spatial clustering methods to explore the geographical variation of malaria patterns, with Kulldorf scan statistic being the most common. Model validation was specified in 53 (50%) studies, with partitioning data into training and validation sets being the common approach. Conclusions Our review highlights the methodological diversity prominent in malaria risk mapping across SSA. To ensure reproducibility and quality science, best practices and transparent approaches should be adopted when selecting the statistical framework and covariates for malaria risk mapping. Findings underscore the need to periodically assess methods and covariates used in malaria risk mapping; to accommodate changes in data availability, data quality and innovation in statistical methodology.
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Affiliation(s)
| | - Chester Kalinda
- Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa.,Faculty of Agriculture and Natural Resources, University of Namibia, Windhoek, Namibia
| | - Peter M Macharia
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Robert W Snow
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Benn Sartorius
- Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa.,Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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24
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Cameron E, Young AJ, Twohig KA, Pothin E, Bhavnani D, Dismer A, Merilien JB, Hamre K, Meyer P, Le Menach A, Cohen JM, Marseille S, Lemoine JF, Telfort MA, Chang MA, Won K, Knipes A, Rogier E, Amratia P, Weiss DJ, Gething PW, Battle KE. Mapping the endemicity and seasonality of clinical malaria for intervention targeting in Haiti using routine case data. eLife 2021; 10:62122. [PMID: 34058123 PMCID: PMC8169118 DOI: 10.7554/elife.62122] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 05/15/2021] [Indexed: 01/26/2023] Open
Abstract
Towards the goal of malaria elimination on Hispaniola, the National Malaria Control Program of Haiti and its international partner organisations are conducting a campaign of interventions targeted to high-risk communities prioritised through evidence-based planning. Here we present a key piece of this planning: an up-to-date, fine-scale endemicity map and seasonality profile for Haiti informed by monthly case counts from 771 health facilities reporting from across the country throughout the 6-year period from January 2014 to December 2019. To this end, a novel hierarchical Bayesian modelling framework was developed in which a latent, pixel-level incidence surface with spatio-temporal innovations is linked to the observed case data via a flexible catchment sub-model designed to account for the absence of data on case household locations. These maps have focussed the delivery of indoor residual spraying and focal mass drug administration in the Grand’Anse Department in South-Western Haiti.
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Affiliation(s)
- Ewan Cameron
- Curtin University, Perth, Australia.,Telethon Kids Institute, Perth Children's Hospital, Perth, Australia
| | - Alyssa J Young
- Clinton Health Access Initiative, Boston, United States.,Tulane University School of Public Health and Tropical Medicine, New Orleans, United States
| | - Katherine A Twohig
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom
| | - Emilie Pothin
- Clinton Health Access Initiative, Boston, United States.,Swiss Tropical and Public Health Institute, Basel, Switzerland
| | | | - Amber Dismer
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, United States
| | | | - Karen Hamre
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, United States
| | - Phoebe Meyer
- Clinton Health Access Initiative, Boston, United States
| | | | | | - Samson Marseille
- Programme National de Contrôle de la Malaria/MSPP, Port-au-Prince, Haiti.,Direction d'Epidémiologie de Laboratoire et de la Recherche, Port-au-Prince, Haiti
| | | | | | - Michelle A Chang
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, United States
| | - Kimberly Won
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, United States
| | - Alaine Knipes
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, United States
| | - Eric Rogier
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, United States
| | - Punam Amratia
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom
| | - Daniel J Weiss
- Curtin University, Perth, Australia.,Telethon Kids Institute, Perth Children's Hospital, Perth, Australia
| | - Peter W Gething
- Curtin University, Perth, Australia.,Telethon Kids Institute, Perth Children's Hospital, Perth, Australia
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25
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Lee J, Lynch CA, Hashiguchi LO, Snow RW, Herz ND, Webster J, Parkhurst J, Erondu NA. Interventions to improve district-level routine health data in low-income and middle-income countries: a systematic review. BMJ Glob Health 2021; 6:e004223. [PMID: 34117009 PMCID: PMC8202107 DOI: 10.1136/bmjgh-2020-004223] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 05/20/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Routine health information system(s) (RHIS) facilitate the collection of health data at all levels of the health system allowing estimates of disease prevalence, treatment and preventive intervention coverage, and risk factors to guide disease control strategies. This core health system pillar remains underdeveloped in many low-income and middle-income countries. Efforts to improve RHIS data coverage, quality and timeliness were launched over 10 years ago. METHODS A systematic review was performed across 12 databases and literature search engines for both peer-reviewed articles and grey literature reports on RHIS interventions. Studies were analysed in three stages: (1) categorisation of RHIS intervention components and processes; (2) comparison of intervention component effectiveness and (3) whether the post-intervention outcome improved above the WHO integrated disease surveillance response framework data quality standard of 80% or above. RESULTS 5294 references were screened, resulting in 56 studies. Three key performance determinants-technical, organisational and behavioural-were proposed as critical to RHIS strengthening. Seventy-seven per cent [77%] of studies identified addressed all three determinants. The most frequently implemented intervention components were 'providing training' and 'using an electronic health management information systems'. Ninety-three per cent [93%] of pre-post or controlled trial studies showed improvements in one or more data quality outputs, but after applying a standard threshold of >80% post-intervention, this number reduced to 68%. There was an observed benefit of multi-component interventions that either conducted data quality training or that addressed improvement across multiple processes and determinants of RHIS. CONCLUSION Holistic data quality interventions that address multiple determinants should be continuously practised for strengthening RHIS. Studies with clearly defined and pragmatic outcomes are required for future RHIS improvement interventions. These should be accompanied by qualitative studies and cost analyses to understand which investments are needed to sustain high-quality RHIS in low-income and middle-income countries.
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Affiliation(s)
- Jieun Lee
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Policy and Programmes Division, World Vision UK, Milton Keynes, UK
| | - Caroline A Lynch
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Lauren Oliveira Hashiguchi
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Robert W Snow
- Population and Health Unit, KEMRI - Wellcome Trust Research Programme, Nairobi, Kenya
- Nuffield Department of Clinical Medicine, University of Oxford Centre for Tropical Medicine and Global Health, Oxford, Oxfordshire, UK
| | - Naomi D Herz
- Medical and Healthcare Innovation, British Heart Foundation, London, UK
| | - Jayne Webster
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Justin Parkhurst
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Ngozi A Erondu
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Centre for Universal Health, Global Health Programme, Chatham House, London, UK
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26
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Kamau A, Mtanje G, Mataza C, Bejon P, Snow RW. Spatial-temporal clustering of malaria using routinely collected health facility data on the Kenyan Coast. Malar J 2021; 20:227. [PMID: 34016100 PMCID: PMC8138976 DOI: 10.1186/s12936-021-03758-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The over-distributed pattern of malaria transmission has led to attempts to define malaria "hotspots" that could be targeted for purposes of malaria control in Africa. However, few studies have investigated the use of routine health facility data in the more stable, endemic areas of Africa as a low-cost strategy to identify hotspots. Here the objective was to explore the spatial and temporal dynamics of fever positive rapid diagnostic test (RDT) malaria cases routinely collected along the Kenyan Coast. METHODS Data on fever positive RDT cases between March 2018 and February 2019 were obtained from patients presenting to six out-patients health-facilities in a rural area of Kilifi County on the Kenyan Coast. To quantify spatial clustering, homestead level geocoded addresses were used as well as aggregated homesteads level data at enumeration zone. Data were sub-divided into quarterly intervals. Kulldorff's spatial scan statistics using Bernoulli probability model was used to detect hotspots of fever positive RDTs across all ages, where cases were febrile individuals with a positive test and controls were individuals with a negative test. RESULTS Across 12 months of surveillance, there were nine significant clusters that were identified using the spatial scan statistics among RDT positive fevers. These clusters included 52% of all fever positive RDT cases detected in 29% of the geocoded homesteads in the study area. When the resolution of the data was aggregated at enumeration zone (village) level the hotspots identified were located in the same areas. Only two of the nine hotspots were temporally stable accounting for 2.7% of the homesteads and included 10.8% of all fever positive RDT cases detected. CONCLUSION Taking together the temporal instability of spatial hotspots and the relatively modest fraction of the malaria cases that they account for; it would seem inadvisable to re-design the sub-county control strategies around targeting hotspots.
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Affiliation(s)
- Alice Kamau
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya. .,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.
| | - Grace Mtanje
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Christine Mataza
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.,Ministry of Health, Kilifi County Government, Kilifi, Kenya
| | - Philip Bejon
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Robert W Snow
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
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27
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Macharia PM, Joseph NK, Snow RW, Sartorius B, Okiro EA. The impact of child health interventions and risk factors on child survival in Kenya, 1993-2014: a Bayesian spatio-temporal analysis with counterfactual scenarios. BMC Med 2021; 19:102. [PMID: 33941185 PMCID: PMC8094495 DOI: 10.1186/s12916-021-01974-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/25/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND During the millennium development goals period, reduction in under-five mortality (U5M) and increases in child health intervention coverage were characterised by sub-national disparities and inequities across Kenya. The contribution of changing risk factors and intervention coverage on the sub-national changes in U5M remains poorly defined. METHODS Sub-national county-level data on U5M and 43 factors known to be associated with U5M spanning 1993 and 2014 were assembled. Using a Bayesian ecological mixed-effects regression model, the relationships between U5M and significant intervention and infection risk ecological factors were quantified across 47 sub-national counties. The coefficients generated were used within a counterfactual framework to estimate U5M and under-five deaths averted (U5-DA) for every county and year (1993-2014) associated with changes in the coverage of interventions and disease infection prevalence relative to 1993. RESULTS Nationally, the stagnation and increase in U5M in the 1990s were associated with rising human immunodeficiency virus (HIV) prevalence and reduced maternal autonomy while improvements after 2006 were associated with a decline in the prevalence of HIV and malaria, increase in access to better sanitation, fever treatment-seeking rates and maternal autonomy. Reduced stunting and increased coverage of early breastfeeding and institutional deliveries were associated with a smaller number of U5-DA compared to other factors while a reduction in high parity and fully immunised children were associated with under-five lives lost. Most of the U5-DA occurred after 2006 and varied spatially across counties. The highest number of U5-DA was recorded in western and coastal Kenya while northern Kenya recorded a lower number of U5-DA than western. Central Kenya had the lowest U5-DA. The deaths averted across the different regions were associated with a unique set of factors. CONCLUSION Contributions of interventions and risk factors to changing U5M vary sub-nationally. This has important implications for targeting future interventions within decentralised health systems such as those operated in Kenya. Targeting specific factors where U5M has been high and intervention coverage poor would lead to the highest likelihood of sub-national attainment of sustainable development goal (SDG) 3.2 on U5M in Kenya.
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Affiliation(s)
- Peter M. Macharia
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Noel K. Joseph
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Robert W. Snow
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Benn Sartorius
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA USA
| | - Emelda A. Okiro
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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28
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Macharia PM, Joseph NK, Sartorius B, Snow RW, Okiro EA. Subnational estimates of factors associated with under-five mortality in Kenya: a spatio-temporal analysis, 1993-2014. BMJ Glob Health 2021; 6:e004544. [PMID: 33858833 PMCID: PMC8054106 DOI: 10.1136/bmjgh-2020-004544] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/26/2021] [Accepted: 03/27/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND To improve child survival, it is necessary to describe and understand the spatial and temporal variation of factors associated with child survival beyond national aggregates, anchored at decentralised health planning units. Therefore, we aimed to provide subnational estimates of factors associated with child survival while elucidating areas of progress, stagnation and decline in Kenya. METHODS Twenty household surveys and three population censuses conducted since 1989 were assembled and spatially aligned to 47 subnational Kenyan county boundaries. Bayesian spatio-temporal Gaussian process regression models accounting for inadequate sample size and spatio-temporal relatedness were fitted for 43 factors at county level between 1993 and 2014. RESULTS Nationally, the coverage and prevalence were highly variable with 38 factors recording an improvement. The absolute percentage change (1993-2014) was heterogeneous ranging between 1% and 898%. At the county level, the estimates varied across space and over time with a majority showing improvements after 2008 which was preceded by a period of deterioration (late-1990 to early-2000). Counties in Northern Kenya were consistently observed to have lower coverage of interventions and remained disadvantaged in 2014 while areas around Central Kenya had and historically have had higher coverage across all intervention domains. Most factors in Western and South-East Kenya recorded moderate intervention coverage although having a high infection prevalence of both HIV and malaria. CONCLUSION The heterogeneous estimates necessitates prioritisation of the marginalised counties to achieve health equity and improve child survival uniformly across the country. Efforts are required to narrow the gap between counties across all the drivers of child survival. The generated estimates will facilitate improved benchmarking and establish a baseline for monitoring child development goals at subnational level.
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Affiliation(s)
- Peter M Macharia
- Population Health Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Noel K Joseph
- Population Health Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Benn Sartorius
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Robert W Snow
- Population Health Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Emelda A Okiro
- Population Health Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Ozodiegwu ID, Ambrose M, Battle KE, Bever C, Diallo O, Galatas B, Runge M, Gerardin J. Beyond national indicators: adapting the Demographic and Health Surveys' sampling strategies and questions to better inform subnational malaria intervention policy. Malar J 2021; 20:122. [PMID: 33648499 PMCID: PMC7919087 DOI: 10.1186/s12936-021-03646-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/11/2021] [Indexed: 11/17/2022] Open
Abstract
In malaria-endemic countries, prioritizing intervention deployment to areas that need the most attention is crucial to ensure continued progress. Global and national policy makers increasingly rely on epidemiological data and mathematical modelling to help optimize health decisions at the sub-national level. The Demographic and Health Surveys (DHS) Program is a critical data source for understanding subnational malaria prevalence and intervention coverage, which are used for parameterizing country-specific models of malaria transmission. However, data to estimate indicators at finer resolutions are limited, and surveys questions have a narrow scope. Examples from the Nigeria DHS are used to highlight gaps in the current survey design. Proposals are then made for additional questions and expansions to the DHS and Malaria Indicator Survey sampling strategy that would advance the data analyses and modelled estimates that inform national policy recommendations. Collaboration between the DHS Program, national malaria control programmes, the malaria modelling community, and funders is needed to address the highlighted data challenges.
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Affiliation(s)
- Ifeoma D Ozodiegwu
- Department of Preventive Medicine and Institute for Global Health, Northwestern University, Chicago, IL, USA.
| | | | | | | | - Ousmane Diallo
- Department of Preventive Medicine and Institute for Global Health, Northwestern University, Chicago, IL, USA
| | - Beatriz Galatas
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | - Manuela Runge
- Department of Preventive Medicine and Institute for Global Health, Northwestern University, Chicago, IL, USA
| | - Jaline Gerardin
- Department of Preventive Medicine and Institute for Global Health, Northwestern University, Chicago, IL, USA
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Alegana VA, Suiyanka L, Macharia PM, Ikahu-Muchangi G, Snow RW. Malaria micro-stratification using routine surveillance data in Western Kenya. Malar J 2021; 20:22. [PMID: 33413385 PMCID: PMC7788718 DOI: 10.1186/s12936-020-03529-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 11/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is an increasing need for finer spatial resolution data on malaria risk to provide micro-stratification to guide sub-national strategic plans. Here, spatial-statistical techniques are used to exploit routine data to depict sub-national heterogeneities in test positivity rate (TPR) for malaria among patients attending health facilities in Kenya. METHODS Routine data from health facilities (n = 1804) representing all ages over 24 months (2018-2019) were assembled across 8 counties (62 sub-counties) in Western Kenya. Statistical model-based approaches were used to quantify heterogeneities in TPR and uncertainty at fine spatial resolution adjusting for missingness, population distribution, spatial data structure, month, and type of health facility. RESULTS The overall monthly reporting rate was 78.7% (IQR 75.0-100.0) and public-based health facilities were more likely than private facilities to report ≥ 12 months (OR 5.7, 95% CI 4.3-7.5). There was marked heterogeneity in population-weighted TPR with sub-counties in the north of the lake-endemic region exhibiting the highest rates (exceedance probability > 70% with 90% certainty) where approximately 2.7 million (28.5%) people reside. At micro-level the lowest rates were in 14 sub-counties (exceedance probability < 30% with 90% certainty) where approximately 2.2 million (23.1%) people lived and indoor residual spraying had been conducted since 2017. CONCLUSION The value of routine health data on TPR can be enhanced when adjusting for underlying population and spatial structures of the data, highlighting small-scale heterogeneities in malaria risk often masked in broad national stratifications. Future research should aim at relating these heterogeneities in TPR with traditional community-level prevalence to improve tailoring malaria control activities at sub-national levels.
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Affiliation(s)
- Victor A Alegana
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, P.O. Box 43640-00100, Nairobi, Kenya. .,Geography and Environmental Science, University of Southampton, Southampton, SO17 1BJ, UK. .,Faculty of Science and Technology, Lancaster University, Lancaster, LAI 4YW, UK.
| | - Laurissa Suiyanka
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, P.O. Box 43640-00100, Nairobi, Kenya
| | - Peter M Macharia
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, P.O. Box 43640-00100, Nairobi, Kenya
| | - Grace Ikahu-Muchangi
- National Malaria Control Programme, Ministry of Health, P.O Box 30016-00100, Nairobi, Kenya
| | - Robert W Snow
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, P.O. Box 43640-00100, Nairobi, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, OX3 7LJ, UK
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31
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Epstein A, Namuganga JF, Kamya EV, Nankabirwa JI, Bhatt S, Rodriguez-Barraquer I, Staedke SG, Kamya MR, Dorsey G, Greenhouse B. Estimating malaria incidence from routine health facility-based surveillance data in Uganda. Malar J 2020; 19:445. [PMID: 33267886 PMCID: PMC7709253 DOI: 10.1186/s12936-020-03514-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/19/2020] [Indexed: 12/03/2022] Open
Abstract
Background Accurate measures of malaria incidence are essential to track progress and target high-risk populations. While health management information system (HMIS) data provide counts of malaria cases, quantifying the denominator for incidence using these data is challenging because catchment areas and care-seeking behaviours are not well defined. This study’s aim was to estimate malaria incidence using HMIS data by adjusting the population denominator accounting for travel time to the health facility. Methods Outpatient data from two public health facilities in Uganda (Kihihi and Nagongera) over a 3-year period (2011–2014) were used to model the relationship between travel time from patient village of residence (available for each individual) to the facility and the relative probability of attendance using Poisson generalized additive models. Outputs from the model were used to generate a weighted population denominator for each health facility and estimate malaria incidence. Among children aged 6 months to 11 years, monthly HMIS-derived incidence estimates, with and without population denominators weighted by probability of attendance, were compared with gold standard measures of malaria incidence measured in prospective cohorts. Results A total of 48,898 outpatient visits were recorded across the two sites over the study period. HMIS incidence correlated with cohort incidence over time at both study sites (correlation in Kihihi = 0.64, p < 0.001; correlation in Nagongera = 0.34, p = 0.045). HMIS incidence measures with denominators unweighted by probability of attendance underestimated cohort incidence aggregated over the 3 years in Kihihi (0.5 cases per person-year (PPY) vs 1.7 cases PPY) and Nagongera (0.3 cases PPY vs 3.0 cases PPY). HMIS incidence measures with denominators weighted by probability of attendance were closer to cohort incidence, but remained underestimates (1.1 cases PPY in Kihihi and 1.4 cases PPY in Nagongera). Conclusions Although malaria incidence measured using HMIS underestimated incidence measured in cohorts, even when adjusting for probability of attendance, HMIS surveillance data are a promising and scalable source for tracking relative changes in malaria incidence over time, particularly when the population denominator can be estimated by incorporating information on village of residence.
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Affiliation(s)
- Adrienne Epstein
- Department of Medicine, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA.
| | | | | | - Joaniter I Nankabirwa
- Infectious Diseases Research Collaboration, Kampala, Uganda.,Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Samir Bhatt
- Department of Infectious Disease Epidemiology, St Marys Hospital, Imperial College, London, UK
| | - Isabel Rodriguez-Barraquer
- Department of Medicine, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
| | | | - Moses R Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda.,Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Grant Dorsey
- Department of Medicine, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
| | - Bryan Greenhouse
- Department of Medicine, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA.,Chan Zuckerberg Biohub, San Francisco, CA, USA
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Mpimbaza A, Sserwanga A, Rutazaana D, Kapisi J, Walemwa R, Suiyanka L, Kyalo D, Kamya M, Opigo J, Snow RW. Changing malaria fever test positivity among paediatric admissions to Tororo district hospital, Uganda 2012-2019. Malar J 2020; 19:416. [PMID: 33213469 PMCID: PMC7678291 DOI: 10.1186/s12936-020-03490-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/09/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The World Health Organization (WHO) promotes long-lasting insecticidal nets (LLIN) and indoor residual house-spraying (IRS) for malaria control in endemic countries. However, long-term impact data of vector control interventions is rarely measured empirically. METHODS Surveillance data was collected from paediatric admissions at Tororo district hospital for the period January 2012 to December 2019, during which LLIN and IRS campaigns were implemented in the district. Malaria test positivity rate (TPR) among febrile admissions aged 1 month to 14 years was aggregated at baseline and three intervention periods (first LLIN campaign; Bendiocarb IRS; and Actellic IRS + second LLIN campaign) and compared using before-and-after analysis. Interrupted time-series analysis (ITSA) was used to determine the effect of IRS (Bendiocarb + Actellic) with the second LLIN campaign on monthly TPR compared to the combined baseline and first LLIN campaign periods controlling for age, rainfall, type of malaria test performed. The mean and median ages were examined between intervention intervals and as trend since January 2012. RESULTS Among 28,049 febrile admissions between January 2012 and December 2019, TPR decreased from 60% at baseline (January 2012-October 2013) to 31% during the final period of Actellic IRS and LLIN (June 2016-December 2019). Comparing intervention intervals to the baseline TPR (60.3%), TPR was higher during the first LLIN period (67.3%, difference 7.0%; 95% CI 5.2%, 8.8%, p < 0.001), and lower during the Bendiocarb IRS (43.5%, difference - 16.8%; 95% CI - 18.7%, - 14.9%) and Actellic IRS (31.3%, difference - 29.0%; 95% CI - 30.3%, - 27.6%, p < 0.001) periods. ITSA confirmed a significant decrease in the level and trend of TPR during the IRS (Bendicarb + Actellic) with the second LLIN period compared to the pre-IRS (baseline + first LLIN) period. The age of children with positive test results significantly increased with time from a mean of 24 months at baseline to 39 months during the final IRS and LLIN period. CONCLUSION IRS can have a dramatic impact on hospital paediatric admissions harbouring malaria infection. The sustained expansion of effective vector control leads to an increase in the age of malaria positive febrile paediatric admissions. However, despite large reductions, malaria test-positive admissions continued to be concentrated in children aged under five years. Despite high coverage of IRS and LLIN, these vector control measures failed to interrupt transmission in Tororo district. Using simple, cost-effective hospital surveillance, it is possible to monitor the public health impacts of IRS in combination with LLIN.
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Affiliation(s)
- Arthur Mpimbaza
- Child Health and Development Centre, Makerere University, College of Health Sciences, Kampala, Uganda.
- Infectious Diseases Research Collaboration, Kampala, Uganda.
| | | | - Damian Rutazaana
- National Malaria Control Division, Ministry of Health, Kampala, Uganda
| | - James Kapisi
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Richard Walemwa
- Department of Prevention, Care and Treatment, Infectious Diseases Institute, Kampala, Uganda
| | - Laurissa Suiyanka
- Population Health Unit, Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
| | - David Kyalo
- Population Health Unit, Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
| | - Moses Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Jimmy Opigo
- National Malaria Control Division, Ministry of Health, Kampala, Uganda
| | - Robert W Snow
- Population Health Unit, Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Arambepola R, Keddie SH, Collins EL, Twohig KA, Amratia P, Bertozzi-Villa A, Chestnutt EG, Harris J, Millar J, Rozier J, Rumisha SF, Symons TL, Vargas-Ruiz C, Andriamananjara M, Rabeherisoa S, Ratsimbasoa AC, Howes RE, Weiss DJ, Gething PW, Cameron E. Spatiotemporal mapping of malaria prevalence in Madagascar using routine surveillance and health survey data. Sci Rep 2020; 10:18129. [PMID: 33093622 PMCID: PMC7581764 DOI: 10.1038/s41598-020-75189-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/12/2020] [Indexed: 11/16/2022] Open
Abstract
Malaria transmission in Madagascar is highly heterogeneous, exhibiting spatial, seasonal and long-term trends. Previous efforts to map malaria risk in Madagascar used prevalence data from Malaria Indicator Surveys. These cross-sectional surveys, conducted during the high transmission season most recently in 2013 and 2016, provide nationally representative prevalence data but cover relatively short time frames. Conversely, monthly case data are collected at health facilities but suffer from biases, including incomplete reporting and low rates of treatment seeking. We combined survey and case data to make monthly maps of prevalence between 2013 and 2016. Health facility catchment populations were estimated to produce incidence rates from the case data. Smoothed incidence surfaces, environmental and socioeconomic covariates, and survey data informed a Bayesian prevalence model, in which a flexible incidence-to-prevalence relationship was learned. Modelled spatial trends were consistent over time, with highest prevalence in the coastal regions and low prevalence in the highlands and desert south. Prevalence was lowest in 2014 and peaked in 2015 and seasonality was widely observed, including in some lower transmission regions. These trends highlight the utility of monthly prevalence estimates over the four year period. By combining survey and case data using this two-step modelling approach, we were able to take advantage of the relative strengths of each metric while accounting for potential bias in the case data. Similar modelling approaches combining large datasets of different malaria metrics may be applicable across sub-Saharan Africa.
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Affiliation(s)
- Rohan Arambepola
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK.
| | - Suzanne H Keddie
- Telethon Kids Institute, Perth Children's Hospital, Perth, Australia
| | - Emma L Collins
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Katherine A Twohig
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Punam Amratia
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Amelia Bertozzi-Villa
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
- Institute for Disease Modeling, Bellevue, WA, USA
| | - Elisabeth G Chestnutt
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Joseph Harris
- Telethon Kids Institute, Perth Children's Hospital, Perth, Australia
| | - Justin Millar
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Jennifer Rozier
- Telethon Kids Institute, Perth Children's Hospital, Perth, Australia
| | - Susan F Rumisha
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Tasmin L Symons
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Camilo Vargas-Ruiz
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Mauricette Andriamananjara
- Programme National de Lutte contre le Paludisme, Antananarivo, Madagascar
- Ministère de Santé Publique, Antananarivo, Madagascar
| | - Saraha Rabeherisoa
- Programme National de Lutte contre le Paludisme, Antananarivo, Madagascar
| | - Arsène C Ratsimbasoa
- Programme National de Lutte contre le Paludisme, Antananarivo, Madagascar
- University of Fianarantsoa, Fianarantsoa, Madagascar
| | - Rosalind E Howes
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - Daniel J Weiss
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
- Telethon Kids Institute, Perth Children's Hospital, Perth, Australia
- Curtin University, Perth, Australia
| | - Peter W Gething
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
- Telethon Kids Institute, Perth Children's Hospital, Perth, Australia
- Curtin University, Perth, Australia
| | - Ewan Cameron
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
- Telethon Kids Institute, Perth Children's Hospital, Perth, Australia
- Curtin University, Perth, Australia
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Gwitira I, Mukonoweshuro M, Mapako G, Shekede MD, Chirenda J, Mberikunashe J. Spatial and spatio-temporal analysis of malaria cases in Zimbabwe. Infect Dis Poverty 2020; 9:146. [PMID: 33092651 PMCID: PMC7584089 DOI: 10.1186/s40249-020-00764-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 10/14/2020] [Indexed: 01/26/2023] Open
Abstract
Background Although effective treatment for malaria is now available, approximately half of the global population remain at risk of the disease particularly in developing countries. To design effective malaria control strategies there is need to understand the pattern of malaria heterogeneity in an area. Therefore, the main objective of this study was to explore the spatial and spatio-temporal pattern of malaria cases in Zimbabwe based on malaria data aggregated at district level from 2011 to 2016. Methods Geographical information system (GIS) and spatial scan statistic were applied on passive malaria data collected from health facilities and aggregated at district level to detect existence of spatial clusters. The global Moran’s I test was used to infer the presence of spatial autocorrelation while the purely spatial retrospective analyses were performed to detect the spatial clusters of malaria cases with high rates based on the discrete Poisson model. Furthermore, space-time clusters with high rates were detected through the retrospective space-time analysis based on the discrete Poisson model. Results Results showed that there is significant positive spatial autocorrelation in malaria cases in the study area. In addition, malaria exhibits spatial heterogeneity as evidenced by the existence of statistically significant (P < 0.05) spatial and space-time clusters of malaria in specific geographic regions. The detected primary clusters persisted in the eastern region of the study area over the six year study period while the temporal pattern of malaria reflected the seasonality of the disease where clusters were detected within particular months of the year. Conclusions Geographic regions characterised by clusters of high rates were identified as malaria high risk areas. The results of this study could be useful in prioritizing resource allocation in high-risk areas for malaria control and elimination particularly in resource limited settings such as Zimbabwe. The results of this study are also useful to guide further investigation into the possible determinants of persistence of high clusters of malaria cases in particular geographic regions which is useful in reducing malaria burden in such areas.
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Affiliation(s)
- Isaiah Gwitira
- Department of Geography Geospatial Sciences and Earth Observation, University of Zimbabwe, P. O. Box MP 167, Mount Pleasant, Harare, Zimbabwe.
| | - Munashe Mukonoweshuro
- Department of Geography Geospatial Sciences and Earth Observation, University of Zimbabwe, P. O. Box MP 167, Mount Pleasant, Harare, Zimbabwe
| | - Grace Mapako
- Department of Geography Geospatial Sciences and Earth Observation, University of Zimbabwe, P. O. Box MP 167, Mount Pleasant, Harare, Zimbabwe
| | - Munyaradzi D Shekede
- Department of Geography Geospatial Sciences and Earth Observation, University of Zimbabwe, P. O. Box MP 167, Mount Pleasant, Harare, Zimbabwe
| | - Joconiah Chirenda
- Department of Community Medicine, University of Zimbabwe, 3rd Floor New Health Sciences Building, College of Health Sciences, P O Box A178, Avondale, Harare, Zimbabwe
| | - Joseph Mberikunashe
- National Malaria Control Program, Ministry of Health and Child Care, 4th Floor, Kaguvi Building, Central Avenue (Between 4th and 5th Street), Harare, Zimbabwe
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Wangdi K, Sarma H, Leaburi J, McBryde E, Clements ACA. Evaluation of the malaria reporting system supported by the District Health Information System 2 in Solomon Islands. Malar J 2020; 19:372. [PMID: 33069245 PMCID: PMC7568381 DOI: 10.1186/s12936-020-03442-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/06/2020] [Indexed: 11/10/2022] Open
Abstract
Background District Health Information Systems 2 (DHIS2) is used for supporting health information management in 67 countries, including Solomon Islands. However, there have been few published evaluations of the performance of DHIS2-enhanced disease reporting systems, in particular for monitoring infectious diseases such as malaria. The aim of this study was to evaluate DHIS2 supported malaria reporting in Solomon Islands and to develop recommendations for improving the system. Methods The evaluation was conducted in three administrative areas of Solomon Islands: Honoria City Council, and Malaita and Guadalcanal Provinces. Records of nine malaria indicators including report submission date, total malaria cases, Plasmodium falciparum case record, Plasmodium vivax case record, clinical malaria, malaria diagnosed with microscopy, malaria diagnosed with (rapid diagnostic test) (RDT), record of drug stocks and records of RDT stocks from 1st January to 31st December 2016 were extracted from the DHIS2 database. The indicators permitted assessment in four core areas: availability, completeness, timeliness and reliability. To explore perceptions and point of view of the stakeholders on the performance of the malaria case reporting system, focus group discussions were conducted with health centre nurses, whilst in-depth interviews were conducted with stakeholder representatives from government (province and national) staff and World Health Organization officials who were users of DHIS2. Results Data were extracted from nine health centres in Honoria City Council and 64 health centres in Malaita Province. The completeness and timeliness from the two provinces of all nine indicators were 28.2% and 5.1%, respectively. The most reliable indicator in DHIS2 was ‘clinical malaria’ (i.e. numbers of clinically diagnosed malaria cases) with 62.4% reliability. Challenges to completeness were a lack of supervision, limited feedback, high workload, and a lack of training and refresher courses. Health centres located in geographically remote areas, a lack of regular transport, high workload and too many variables in the reporting forms led to delays in timely reporting. Reliability of reports was impacted by a lack of technical professionals such as statisticians and unavailability of tally sheets and reporting forms. Conclusion The availability, completeness, timeliness and reliability of nine malaria indicators collected in DHIS2 were variable within the study area, but generally low. Continued onsite support, supervision, feedback and additional enhancements, such as electronic reporting will be required to further improve the malaria reporting system.
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Affiliation(s)
- Kinley Wangdi
- Department of Global Health, Research School of Population Health, College of Health and Medicine, The Australian National University, 62 Mills Road, Canberra, ACT 2601, Australia.
| | - Haribondu Sarma
- National Centre of Epidemiology and Population Health, Research School of Population Health, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - John Leaburi
- National Vector Borne Disease Control Programme, Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Emma McBryde
- Australian Institute of Tropical Health & Medicine, Centre for Biosecurity in Tropical Infectious Diseases, James Cooks University, Townsville, Australia
| | - Archie C A Clements
- Faculty of Health Sciences, Curtin University, Bentley, Australia.,Telethon Kids Institute, Nedlands, Australia
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Kamau A, Mtanje G, Mataza C, Malla L, Bejon P, Snow RW. The relationship between facility-based malaria test positivity rate and community-based parasite prevalence. PLoS One 2020; 15:e0240058. [PMID: 33027313 PMCID: PMC7540858 DOI: 10.1371/journal.pone.0240058] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 09/17/2020] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Malaria surveillance is a key pillar in the control of malaria in Africa. The value of using routinely collected data from health facilities to define malaria risk at community levels remains poorly defined. METHODS Four cross-sectional parasite prevalence surveys were undertaken among residents at 36 enumeration zones in Kilifi county on the Kenyan coast and temporally and spatially matched to fever surveillance at 6 health facilities serving the same communities over 12 months. The age-structured functional form of the relationship between test positivity rate (TPR) and community-based parasite prevalence (PR) was explored through the development of regression models fitted by alternating the linear, exponential and polynomial terms for PR. The predictive ranges of TPR were explored for PR endemicity risk groups of control programmatic value using cut-offs of low (PR <5%) and high (PR ≥ 30%) transmission intensity. RESULTS Among 28,134 febrile patients encountered for malaria diagnostic testing in the health facilities, 12,143 (43.2%: 95% CI: 42.6%, 43.7%) were positive. The overall community PR was 9.9% (95% CI: 9.2%, 10.7%) among 6,479 participants tested for malaria. The polynomial model was the best fitting model for the data that described the algebraic relationship between TPR and PR. In this setting, a TPR of ≥ 49% in all age groups corresponded to an age-standardized PR of ≥ 30%, while a TPR of < 40% corresponded to an age-standardized PR of < 5%. CONCLUSION A non-linear relationship was observed between the relative change in TPR and changes in the PR, which is likely to have important implications for malaria surveillance programs, especially at the extremes of transmission. However, larger, more spatially diverse data series using routinely collected TPR data matched to community-based infection prevalence data are required to explore the more practical implications of using TPR as a replacement for community PR.
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Affiliation(s)
- Alice Kamau
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- * E-mail:
| | - Grace Mtanje
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Christine Mataza
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Ministry of Health, Kilifi County Government, Kilifi, Kenya
| | - Lucas Malla
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Philip Bejon
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Robert W. Snow
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
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Addressing challenges in routine health data reporting in Burkina Faso through Bayesian spatiotemporal prediction of weekly clinical malaria incidence. Sci Rep 2020; 10:16568. [PMID: 33024162 PMCID: PMC7538437 DOI: 10.1038/s41598-020-73601-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 09/07/2020] [Indexed: 11/15/2022] Open
Abstract
Sub-Saharan African (SSA) countries’ health systems are often vulnerable to unplanned situations that can hinder their effectiveness in terms of data completeness and disease control. For instance, in Burkina Faso following a workers' strike, comprehensive data on several diseases were unavailable for a long period in 2019. Weather, seasonal-malaria-chemoprevention (SMC), free healthcare, and other contextual data, which are purported to influence malarial disease, provide opportunities to fit models to describe the clinical malaria data and predict the disease spread. Bayesian spatiotemporal modeling was applied to weekly malaria surveillance data from Burkina Faso (2011–2018) while considering the effects of weather, health programs and contextual factors. Then, a prediction was used to deal with weekly missing data for the entire year of 2019, and SMC and free healthcare effects were quantified. Our proposed model accurately predicted weekly clinical malaria incidence (correlation coefficient, r = 0.90). The distribution of clinical malaria incidence was heterogeneous across the country. Overall, national predicted clinical malaria incidence in 2019 (605 per 1000 [95% CrI: 360–990]) increased by 24.7% compared with the year 2015. SMC and the interaction between free healthcare and health facility attendance were associated with a reduction in clinical malaria incidence. Our modeling approach could be a useful tool for strengthening health systems’ resilience by addressing data completeness and could support SSA countries in developing appropriate targets and indicators to facilitate the subnational control effort.
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Ghilardi L, Okello G, Nyondo-Mipando L, Chirambo CM, Malongo F, Hoyt J, Lee J, Sedekia Y, Parkhurst J, Lines J, Snow RW, Lynch CA, Webster J. How useful are malaria risk maps at the country level? Perceptions of decision-makers in Kenya, Malawi and the Democratic Republic of Congo. Malar J 2020; 19:353. [PMID: 33008465 PMCID: PMC7530951 DOI: 10.1186/s12936-020-03425-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 09/23/2020] [Indexed: 11/24/2022] Open
Abstract
Background Declining malaria prevalence and pressure on external funding have increased the need for efficiency in malaria control in sub-Saharan Africa (SSA). Modelled Plasmodium falciparum parasite rate (PfPR) maps are increasingly becoming available and provide information on the epidemiological situation of countries. However, how these maps are understood or used for national malaria planning is rarely explored. In this study, the practices and perceptions of national decision-makers on the utility of malaria risk maps, showing prevalence of parasitaemia or incidence of illness, was investigated. Methods A document review of recent National Malaria Strategic Plans was combined with 64 in-depth interviews with stakeholders in Kenya, Malawi and the Democratic Republic of Congo (DRC). The document review focused on the type of epidemiological maps included and their use in prioritising and targeting interventions. Interviews (14 Kenya, 17 Malawi, 27 DRC, 6 global level) explored drivers of stakeholder perceptions of the utility, value and limitations of malaria risk maps. Results 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). 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. Maps were also used for operational planning, supply quantification, financial justification and advocacy. Findings from the interviews suggested that decision-makers lacked trust in the modelled PfPR maps when based on only a few empirical data points (Malawi and DRC). Conclusions Maps were generally used to identify areas with high prevalence in order to implement specific interventions. Despite the availability of national level modelled PfPR maps in all three countries, they were only used in one country. 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.
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Affiliation(s)
- Ludovica Ghilardi
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK.
| | - George Okello
- Kenya Medical Research Institute-Wellcome Trust Research Programme, P.O. Box 43640-00100, Nairobi, Kenya
| | - Linda Nyondo-Mipando
- Department of Health Systems and Policy, College of Medicine, University of Malawi, Blantyre, Malawi
| | | | - Fathy Malongo
- Kinshasa School of Public Health, University of Kinshasa, Mont Amba/Lemba, BP 11850 Kin I, Kinshasa, Democratic Republic of Congo
| | - Jenna Hoyt
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Jieun Lee
- World Vision UK, 1rb, 11 Belgrave Rd, Pimlico, London, SW1V 1RB, UK
| | - Yovitha Sedekia
- Mwanza Intervention Trials Unit (MITU)/ National Institute for Medical Research (NIMR)- Mwanza Research Centre, P.O BOX 11936, Isamilo road, Mwanza, Tanzania
| | - Justin Parkhurst
- London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
| | - Jo Lines
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Robert W Snow
- Kenya Medical Research Institute-Wellcome Trust Research Programme, P.O. Box 43640-00100, Nairobi, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, OX3 7LJ, Oxford, UK
| | - Caroline A Lynch
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Jayne Webster
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
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Wairoto KG, Joseph NK, Macharia PM, Okiro EA. Determinants of subnational disparities in antenatal care utilisation: a spatial analysis of demographic and health survey data in Kenya. BMC Health Serv Res 2020; 20:665. [PMID: 32682421 PMCID: PMC7368739 DOI: 10.1186/s12913-020-05531-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 07/13/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The spatial variation in antenatal care (ANC) utilisation is likely associated with disparities observed in maternal and neonatal deaths. Most maternal deaths are preventable through services offered during ANC; however, estimates of ANC coverage at lower decision-making units (sub-county) is mostly lacking. In this study, we aimed to estimate the coverage of at least four ANC (ANC4) visits at the sub-county level using the 2014 Kenya Demographic and Health Survey (KDHS 2014) and identify factors associated with ANC utilisation in Kenya. METHODS Data from the KDHS 2014 was used to compute sub-county estimates of ANC4 using small area estimation (SAE) techniques which relied on spatial relatedness to yield precise and reliable estimates at each of the 295 sub-counties. Hierarchical mixed-effect logistic regression was used to identify factors influencing ANC4 utilisation. Sub-county estimates of factors significantly associated with ANC utilisation were produced using SAE techniques and mapped to visualise disparities. RESULTS The coverage of ANC4 across sub-counties was heterogeneous, ranging from a low of 17% in Mandera West sub-county to over 77% in Nakuru Town West and Ruiru sub-counties. Thirty-one per cent of the 295 sub-counties had coverage of less than 50%. Maternal education, household wealth, place of delivery, marital status, age at first marriage, and birth order were all associated with ANC utilisation. The areas with low ANC4 utilisation rates corresponded to areas of low socioeconomic status, fewer educated women and a small number of health facility deliveries. CONCLUSION Suboptimal coverage of ANC4 and its heterogeneity at sub-county level calls for urgent, focused and localised approaches to improve access to antenatal care services. Policy formulation and resources allocation should rely on data-driven strategies to guide national and county governments achieve equity in access and utilisation of health interventions.
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Affiliation(s)
- Kefa G. Wairoto
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Noel K. Joseph
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Peter M. Macharia
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Emelda A. Okiro
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, OX3 7LJ UK
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