School-Based Serosurveys to Assess the Validity of Using Routine Health Facility Data to Target Malaria Interventions in the Central Highlands of Madagascar

Laura C. Steinhardt (1) , Elisabeth Ravaoarisoa (2, 3) , Ryan Wiegand (1) , Aina Harimanana (4) , Judith Hedje (1, 5) , Annett H. Cotte (1, 6) , Sixte Zigirumugabe (5, 7) , Thomas Kesteman (2, 8) , Tsikiniaina L. Rasoloharimanana (9) , Emma Rakotomalala (9) , Anny M. Randriamoramanana (4) , Jean-Marius Rakotondramanga (4) , Seheno Razanatsiorimalala (2) , Odile Mercereau-Puijalon (10) , Ronald Perraut (11) , Arsène Ratsimbasoa (12, 3, 13) , Jessica Butts (1, 6) , Christophe Rogier (13, 14) , Patrice Piola (4, 15) , Milijaona Randrianarivelojosia (2) , Inès Vigan-Womas (9)

1 CDC - Centers for Disease Control and Prevention [Atlanta]
2 IPM - G4 malaria group [Antananarivo, Madagascar]
3 Université d'Antananarivo
4 IPM - Unité d'Epidémiologie [Antananarivo, Madagascar]
5 PMI - U.S. President’s Malaria Initiative [Antananarivo]
6 PMI - U.S.President's Malaria Initiative
7 AGENCY FOR INTERNATIONAL DEVELOPMENT WASHINGTON USA
8 Fondation Mérieux
9 IPM - Unité d'immunologie des maladies infectieuses [Antananarivo, Madagascar]
10 Département Parasites et Insectes vecteurs - Department of Parasites and Insect Vectors
11 Institut Pasteur de Dakar
12 Ministère de la Santé Publique [Antananarivo, Madagascar]
13 IHU Marseille - Institut Hospitalier Universitaire Méditerranée Infection
14 Institut Pasteur de Madagascar
15 Unité d'Épidémiologie et de Santé Publique [Phnom Penh]

Background In low-malaria–transmission areas of Madagascar, annual parasite incidence (API) from routine data has been used to target indoor residual spraying at subdistrict commune level. To assess validity of this approach, we conducted school-based serological surveys and health facility (HF) data quality assessments in 7 districts to compare API to gold-standard commune-level serological measures. Methods At 2 primary schools in each of 93 communes, 60 students were randomly selected with parents and teachers. Capillary blood was drawn for rapid diagnostic tests (RDTs) and serology. Multiplex bead-based immunoassays to detect antibodies to 5 Plasmodium falciparum antigens were conducted, and finite mixture models used to characterize seronegative and seropositive populations. Reversible catalytic models generated commune-level annual seroconversion rates (SCRs). HF register data were abstracted to assess completeness and accuracy. Results RDT positivity from 12 770 samples was 0.5%. Seroprevalence to tested antigens ranged from 17.9% (MSP-1) to 59.7% (PF13). Median commune-level SCR was 0.0108 (range, 0.001–0.075). Compared to SCRs, API identified 71% (95% confidence interval, 51%–87%) of the 30% highest-transmission communes; sensitivity declined at lower levels. Routine data accuracy did not substantially affect API performance. Conclusions API performs reasonably well at identifying higher-transmission communes but sensitivity declined at lower transmission levels.

Keywords: serology; school-based surveys; malaria; Madagascar; stratification

Domains: Life Sciences [q-bio]; Microbiology and Parasitology; Life Sciences [q-bio]; Immunology; Life Sciences [q-bio]; Cellular Biology; Life Sciences [q-bio]; Biochemistry, Molecular Biology; Molecular biology; Life Sciences [q-bio]; Santé publique et épidémiologie

Laura C. Steinhardt, Elisabeth Ravaoarisoa, Ryan Wiegand, Aina Harimanana, Judith Hedje, et al.. School-Based Serosurveys to Assess the Validity of Using Routine Health Facility Data to Target Malaria Interventions in the Central Highlands of Madagascar. Journal of Infectious Diseases, 2020, XX, pp.1-10. ⟨10.1093/infdis/jiaa476⟩. ⟨pasteur-02937032⟩