Comparison of surveillance methods applied to a situation of low malaria prevalence at rural sites in The Gambia and Guinea Bissau.
BACKGROUND
Health record-based observations from several parts of Africa indicate a major decline in malaria, but up-to-date information on parasite prevalence in West-Africa is sparse. This study aims to provide parasite prevalence data from three sites in the Gambia and Guinea Bissau, respectively, and compares the usefulness of PCR, rapid diagnostic tests (RDT), serology and slide-microscopy for surveillance.


METHODS
Cross-sectional surveys in 12 villages at three rural sites were carried out in the Gambia and Guinea Bissau in January/February 2008, shortly following the annual transmission season.


RESULTS
A surprisingly low microscopically detectable parasite prevalence was detected in the Gambia (Farafenni: 10.9%, CI95%: 8.7-13.1%; Basse: 9.0%, CI95%: 7.2-10.8%), and Guinea Bissau (Caio: 4%, CI95%: 2.6-5.4%), with low parasite densities (geometric mean: 104 parasites/microl, CI95%: 76-143/microl). In comparison, PCR detected a more than three times higher proportion of parasite carriers, indicating its usefulness to sensitively identify foci where malaria declines, whereas the RDT had very low sensitivity. Estimates of force of infection using age sero-conversion rates were equivalent to an EIR of approximately 1 infectious bite/person/year, significantly less than previous estimates. The sero-prevalence profiles suggest a gradual decline of malaria transmission, confirming their usefulness in providing information on longer term trends of transmission. A greater variability in parasite prevalence among villages within a site than between sites was observed with all methods. The fact that serology equally captured the inter-village variability, indicates that the observed heterogeneity represents a stable pattern.


CONCLUSIONS
PCR and serology may be used as complementary tools to survey malaria in areas of declining malaria prevalence such as the Gambia and Guinea Bissau.
Satoguina
Judith
J
Medical Research Council Laboratories, Fajara, PO Box 273 Banjul, The Gambia. jsatoguina@mrc.gm
Walther
Brigitte
B
Drakeley
Christopher
C
Nwakanma
Davis
D
Oriero
Eniyou C
EC
Correa
Simon
S
Corran
Patrick
P
Conway
David J
DJ
Walther
Michael
M
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000818:Animals; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D005714:Gambia / Q000453:epidemiology; D006169:Guinea-Bissau / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016778:Malaria, Falciparum / Q000175:diagnosis* / Q000453:epidemiology / Q000469:parasitology; D008297:Male; D008853:Microscopy / Q000592:standards; D008875:Middle Aged; D018512:Parasitemia / Q000175:diagnosis* / Q000453:epidemiology; D010963:Plasmodium falciparum / Q000302:isolation & purification*; D016133:Polymerase Chain Reaction / Q000379:methods / Q000592:standards; D011159:Population Surveillance / Q000379:methods*; D015995:Prevalence; D012424:Rural Population; D012621:Seasons; D012680:Sensitivity and Specificity; D055815:Young Adult