Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia.
PATH, Kampala, Uganda.
Am J Trop Med Hyg. 2022 Jun 6;108(2_Suppl):4-7. doi: 10.4269/ajtmh.22-0182. Print 2023 Feb 2.
Most monitoring and evaluation tools for measuring malaria burden, intervention coverage, and impact of interventions use periodic nationally representative cross-sectional household surveys. These provide advantages in terms of selecting a large, unbiased, population-based sample; however, they are infrequently conducted, are resource-intensive, and do not provide longitudinal data with sufficient granularity. Given the heterogeneity of malaria transmission within most endemic countries, systems with the capacity to provide more granular and frequent data would be more actionable by national malaria control programs and local implementing partners. There is increasing interest in using routine health facility data, usually from outpatient department visits, for monitoring malaria burden. Data from pregnant women attending antenatal care (ANC) could minimize bias related to fever care-seeking among outpatient department visits and provide more granular parasite prevalence data. Most pregnant women attend ANC at least once and are thus highly representative of the overall pregnant population. A growing body of evidence suggests that malaria parasitemia in pregnant women is correlated with parasitemia in children aged < 5 years in moderate to high transmission areas, allowing for monitoring parasitemia in real time. Additional data are needed to assess whether pregnant women are sufficiently representative of the overall population to yield valid malaria prevalence and intervention coverage estimates. Although use of routinely collected ANC data faces many of the same challenges experienced by other routinely collected health facility data, the opportunity to improve parasite prevalence monitoring and the associated health benefits to mothers and infants of early detection of parasitemia make these efforts valuable.
大多数用于衡量疟疾负担、干预措施覆盖率和干预措施效果的监测和评估工具都使用定期进行的全国代表性横断面家庭调查。这些调查在选择大规模、无偏倚、基于人群的样本方面具有优势；然而，它们的实施频率较低，资源密集，并且不能提供具有足够粒度的纵向数据。鉴于大多数流行国家内疟疾传播的异质性，具有提供更细粒度和更频繁数据能力的系统将更有利于国家疟疾控制规划和地方实施伙伴采取行动。越来越多的人有兴趣使用常规卫生机构数据（通常来自门诊就诊）来监测疟疾负担。来自接受产前护理 (ANC) 的孕妇的数据可以最大限度地减少因在门诊就诊时寻求发热治疗而产生的偏倚，并提供更细粒度的寄生虫流行数据。大多数孕妇至少接受一次 ANC，因此非常代表总体孕妇人群。越来越多的证据表明，在中度至高度传播地区，孕妇中的疟疾寄生虫血症与年龄 < 5 岁的儿童中的寄生虫血症相关，从而可以实时监测寄生虫血症。需要更多数据来评估孕妇是否足以代表总体人群，以得出有效的疟疾流行率和干预措施覆盖率估计。尽管使用常规收集的 ANC 数据面临着与其他常规收集的卫生机构数据相同的许多挑战，但改善寄生虫流行监测的机会以及早期发现寄生虫血症对母亲和婴儿的相关健康益处使得这些努力具有价值。
