Malaria Hotspots: Is There Epidemiological Evidence for Fine-Scale Spatial Targeting of Interventions?

Stresman, Gillian; Bousema, Teun; Cook, Jackie

doi:10.1016/j.pt.2019.07.013

Cited by 56 publications

(66 citation statements)

References 109 publications

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“…Our results support previous findings from Venezuela, Brazil and Peru showing that P. vivax malaria spatial heterogeneity is characterized by localities of high risk interspersed with others of moderate or low risk [11,30,31,32]. Due to their stability or persistence over time, the hotspots detected here could be predictive of prospective malaria incidence in the surrounding areas as has been found in other studies [33,34,35].…”

Section: Discussionsupporting

confidence: 92%

Malaria in Southern Venezuela: The Hottest Hotspot in Latin America

Grillet

Moreno²,

Hernandez

et al. 2020

Preprint

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Malaria cases in Latin America reached ~1 million in 2017 and 2018, with 53% and 51% reported from Venezuela, respectively. In this study, we characterized the spatiotemporal dynamics of malaria transmission between 2007-2017 in southern Venezuela, the main endemic area of the country. We found that disease transmission was focal and more prevalent in the southeast of southern Venezuela where two persistent hotspots of Plasmodium vivax (76%) and P. falciparum (18%) linked to deforestation for illegal gold mining accounted for ~60% of the country-wide number of cases. Incidence has increased nearly tenfold in the last decade, showing an explosive epidemic growth due to a significant lack of disease control. We suggest that a source-sink pattern of Plasmodium sp.dispersal account for the re-emergence and progression of malaria transmission in the last 4 years across the country due to the internal migration of infected people to and from the hotspots and other malaria-prone ecosystems. We observe a similar pattern explaining the spillover of cases across international borders affecting neighboring countries. This study provides baseline epidemiological data and guidance for malaria control to further assess the dynamics of cross-border malaria, the role of asymptomatic carriers, drug-resistant evolution, and innovative control efforts in the Latin America region.

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Section: Discussionsupporting

confidence: 92%

Malaria in Southern Venezuela: The Hottest Hotspot in Latin America

Grillet

Moreno²,

Hernandez

et al. 2020

Preprint

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“…Prioritisation and targeting are often di cult to disentangle and in fact in practice, one inevitably implies the other, but in general prioritisation refers to the type of intervention or the type of delivery method that should be selected for a given geographical area (34); where as targeting is about which geographical areas and/or sub-populations should the intervention and delivery method be deployed in (35)(36)(37).…”

Section: Methodsmentioning

confidence: 99%

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

Ghilardi

Okello

Nyondo-Mipando

et al. 2020

Preprint

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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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“…The review was supplemented with IDIs and aimed to elucidate practises and perceptions of stakeholders on the utility of risk maps in their decision-making, in particular, how these maps affect prioritization and targeting of interventions, along with the reasoning behind their decisions. Prioritization and targeting are often di cult to disentangle and in fact in practice, one inevitably implies the other, but in general prioritization refers to the type of intervention or the type of delivery method that should be selected for a given geographical area [31]; where as targeting is about which geographical areas and/or sub-populations should the intervention and delivery method be deployed in [32][33][34]. Document review The latest NMSPs were reviewed for each of the three countries to identify the type of malaria risk maps included (e.g.…”

Section: Methodsmentioning

confidence: 99%

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

Ghilardi

Okello

Nyondo-Mipando

et al. 2020

Preprint

View full text Add to dashboard Cite

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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Malaria Hotspots: Is There Epidemiological Evidence for Fine-Scale Spatial Targeting of Interventions?

Cited by 56 publications

References 109 publications

Malaria in Southern Venezuela: The Hottest Hotspot in Latin America

Malaria in Southern Venezuela: The Hottest Hotspot in Latin America

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

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

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