School-Based Serosurveys to Assess the Validity of Using Routine Health Facility Data to Target Malaria Interventions in the Central Highlands of Madagascar. (6th August 2020)

• Record Type: Journal Article
• Authors: Steinhardt, Laura C; Ravaoarisoa, Elisabeth; Wiegand, Ryan; Harimanana, Aina; Hedje, Judith; Cotte, Annett H; Zigirumugabe, Sixte; Kesteman, Thomas; Rasoloharimanana, Tsikiniaina L; Rakotomalala, Emma; Randriamoramanana, Anny M; Rakotondramanga, Jean-Marius; Razanatsiorimalala, Seheno; Mercereau-Puijalon, Odile; Perraut, Ronald; Ratsimbasoa, Arsène; Butts, Jessica; Rogier, Christophe; Piola, Patrice; Randrianarivelojosia, Milijaona; Vigan-Womas, Inès
• Is Part Of: Journal of infectious diseases. Volume 223:Number 6(2021)
• Page Start: 995
• Page End: 1004
• Publication Date: 2020-08-06
• Subjects: serology -- school-based surveys -- malaria -- Madagascar -- stratification; Communicable diseases -- Periodicals; Diseases -- Causes and theories of causation -- Periodicals; Medicine -- Periodicals; Communicable Diseases -- Periodicals; Electronic journals; 616.9
• DOI: 10.1093/infdis/jiaa476
• Languages: English
• ISSNs: 0022-1899

Abstract

Abstract: Background: In low-malaria–transmission areas of Madagascar, annual parasite incidence (API) from routine data has been used to target indoor residual spraying at subdistrict commune level. To assess validity of this approach, we conducted school-based serological surveys and health facility (HF) data quality assessments in 7 districts to compare API to gold-standard commune-level serological measures. Methods: At 2 primary schools in each of 93 communes, 60 students were randomly selected with parents and teachers. Capillary blood was drawn for rapid diagnostic tests (RDTs) and serology. Multiplex bead-based immunoassays to detect antibodies to 5 Plasmodium falciparum antigens were conducted, and finite mixture models used to characterize seronegative and seropositive populations. Reversible catalytic models generated commune-level annual seroconversion rates (SCRs). HF register data were abstracted to assess completeness and accuracy. Results: RDT positivity from 12 770 samples was 0.5%. Seroprevalence to tested antigens ranged from 17.9% (MSP-1) to 59.7% (PF13). Median commune-level SCR was 0.0108 (range, 0.001–0.075). Compared to SCRs, API identified 71% (95% confidence interval, 51%–87%) of the 30% highest-transmission communes; sensitivity declined at lower levels. Routine data accuracy did not substantially affect API performance. Conclusions: API performs reasonably well at identifying higher-transmission communes but sensitivity declined at lower transmission levels. Abstract : Using school-based serological surveys as a gold standard for transmission intensity a low-transmission area of Madagascar, annual parasite incidence from routine health facility malaria data performed reasonably well at identifying higher-transmission communes, but sensitivity declined at lower transmission levels.