title: Pregnant women and infants as sentinel populations to monitor prevalence of malaria: results of pilot study in Lake Zone of Tanzania.
abstract: As malaria control interventions are scaled-up, rational approaches are needed for monitoring impact over time. One proposed approach includes monitoring the prevalence of malaria infection among pregnant women and children at the time of routine preventive health facility (HF) visits. This pilot explored the feasibility and utility of tracking the prevalence of malaria infection in pregnant women attending their first antenatal care (ANC) visit and infants presenting at 9-12 months of age for measles vaccination.
  
  
  
  Pregnant women attending first ANC and infants nine to 12 months old presenting for measles vaccination at a non-probability sample of 54 HFs in Tanzania's Lake Zone (Mara, Mwanza and Kagera Regions) were screened for malaria infection using a malaria rapid diagnostic test (RDT) from December 2012 to November 2013, regardless of symptoms. Participants who tested positive were treated for malaria per national guidelines. Data were collected monthly.
  
  
  
  Overall 89.9 and 78.1 % of expected monthly reports on malaria infection prevalence were received for pregnant women and infants, respectively. Among 51,467 pregnant women and 35,155 infants attending routine preventive HF visits, 41.2 and 37.3 % were tested with RDT, respectively. Malaria infection prevalence was 12.8 % [95 % confidence interval (CI) 11.3-14.3] among pregnant women and 11.0 % (95 % CI 9.5-12.5) among infants, and varied by month. There was good correlation of the prevalence of malaria among pregnant women and infants at the HF level (Spearman rho = 0.6; p < 0.001). This approach is estimated to cost $1.28 for every person tested, with the RDT accounting for 72 % of the cost.
  
  
  
  Malaria infection was common and well correlated among pregnant women and infants attending routine health services. Routine screening of these readily accessible populations may offer a practical strategy for continuously tracking malaria trends, particularly seasonal variation. Positivity rates among afebrile individuals presenting for routine care offer an advantage as they are unaffected by the prevalence of other causes of febrile illness, which could influence positivity rates among febrile patients presenting to outpatient clinics. The data presented here suggest that in addition to contributing to clinical management, ongoing screening of pregnant women could be used for routine surveillance and detection of hotspots.
authors.affiliation: RTI International, Dar es Salaam, Tanzania. rithawillilo@gmail.com.
authors.forename: Ritha A
authors.initials: RA
authors.lastname: Willilo
authors.affiliation: National Malaria Control Programme, Dar es Salaam, Tanzania.|Swiss Tropical and Public Health Institute, Dar es Salaam, Tanzania.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Molteni
authors.affiliation: National Malaria Control Programme, Dar es Salaam, Tanzania.
authors.forename: Renata
authors.initials: R
authors.lastname: Mandike
authors.affiliation: Sengerema Health Institute, Sengerema, Tanzania.
authors.forename: Frances E
authors.initials: FE
authors.lastname: Mugalura
authors.affiliation: RTI International, Dar es Salaam, Tanzania.
authors.forename: Anold
authors.initials: A
authors.lastname: Mutafungwa
authors.affiliation: RTI International, Dar es Salaam, Tanzania.
authors.forename: Adella
authors.initials: A
authors.lastname: Thadeo
authors.affiliation: RTI International, Dar es Salaam, Tanzania.
authors.forename: Edwin
authors.initials: E
authors.lastname: Benedictor
authors.affiliation: President's Malaria Initiative/United States Agency for International Development, Abuja, Nigeria.
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Kafuko
authors.affiliation: President's Malaria Initiative/United States Agency for International Development, Dar es Salaam, Tanzania.
authors.forename: Naomi
authors.initials: N
authors.lastname: Kaspar
authors.affiliation: RTI International, Dar es Salaam, Tanzania.
authors.forename: Mahdi M
authors.initials: MM
authors.lastname: Ramsan
authors.affiliation: RTI International, Dar es Salaam, Tanzania.
authors.forename: Osia
authors.initials: O
authors.lastname: Mwaipape
authors.affiliation: President's Malaria Initiative and Malaria Branch, Centers for Disease Control and Prevention, Atlanta, USA.
authors.forename: Peter D
authors.initials: PD
authors.lastname: McElroy
authors.affiliation: Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Julie
authors.initials: J
authors.lastname: Gutman
authors.affiliation: RTI international, Washington DC, USA.
authors.forename: Rajeev
authors.initials: R
authors.lastname: Colaco
authors.affiliation: RTI international, Washington DC, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Reithinger
authors.affiliation: RTI International, Dar es Salaam, Tanzania.
authors.forename: Jeremiah M
authors.initials: JM
authors.lastname: Ngondi
mesh_terms: D003955:Diagnostic Tests, Routine; D005260:Female; D006801:Humans; D007115:Immunization Schedule; D007223:Infant; D008288:Malaria / Q000453:epidemiology*; D010865:Pilot Projects; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology*; D011295:Prenatal Care; D015995:Prevalence; D018571:Sentinel Surveillance; D013636:Tanzania / Q000453:epidemiology
keywords: Infants; Malaria surveillance; Pregnant women; Sentinel population; Tanzania