Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002, Basel, Switzerland.
University of Basel, Petersplatz 1, 4003, Basel, Switzerland.
Malar J. 2019 Nov 21;18(1):370. doi: 10.1186/s12936-019-2999-0.
With increasing spatial heterogeneity of malaria transmission and a shift of the disease burden towards older children and adults, pregnant women attending antenatal care (ANC) have been proposed as a pragmatic sentinel population for malaria surveillance. However, the representativeness of routine ANC malaria test-positivity and its relationship with prevalence in other population subgroups are yet to be investigated.
Monthly ANC malaria test-positivity data from all Tanzanian health facilities for January 2014 to May 2016 was compared to prevalence data from the School Malaria Parasitaemia Survey 2015, the Malaria Indicator Survey (MIS) 2015/16, the Malaria Atlas Project 2015, and a Bayesian model fitted to MIS data. Linear regression was used to describe the difference between malaria test-positivity in pregnant women and respective comparison groups as a function of ANC test-positivity and potential covariates.
The relationship between ANC test-positivity and survey prevalence in children follows spatially and biologically meaningful patterns. However, the uncertainty of the relationship was substantial, particularly in areas with high or perennial transmission. In comparison, modelled data estimated higher prevalence in children at low transmission intensities and lower prevalence at higher transmission intensities.
Pregnant women attending ANC are a pragmatic sentinel population to assess heterogeneity and trends in malaria prevalence in Tanzania. Yet, since ANC malaria test-positivity cannot be used to directly predict the prevalence in other population subgroups, complementary community-level measurements remain highly relevant.
随着疟疾传播的空间异质性不断增加，疾病负担逐渐转向年龄较大的儿童和成人，因此建议孕妇接受产前护理（ANC）作为疟疾监测的实用哨点人群。然而，常规 ANC 疟疾检测阳性率的代表性及其与其他人群亚组患病率的关系尚未得到调查。
比较 2014 年 1 月至 2016 年 5 月期间所有坦桑尼亚卫生机构的每月 ANC 疟疾检测阳性数据与 2015 年学校疟疾寄生虫病调查、2015/16 年疟疾指标调查（MIS）、2015 年疟疾地图集项目和拟合到 MIS 数据的贝叶斯模型的患病率数据。线性回归用于描述孕妇疟疾检测阳性率与各自比较组之间的差异，其函数为 ANC 检测阳性率和潜在协变量。
儿童 ANC 检测阳性率与调查患病率之间的关系遵循空间和生物学上有意义的模式。然而，这种关系的不确定性很大，尤其是在高或常年传播的地区。相比之下，模型数据估计在低传播强度下儿童的患病率较高，在高传播强度下的患病率较低。
参加 ANC 的孕妇是评估坦桑尼亚疟疾患病率异质性和趋势的实用哨点人群。然而，由于 ANC 疟疾检测阳性率不能直接预测其他人群亚组的患病率，因此仍需要进行补充的社区层面测量。
