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Plasmodium falciparum parasite prevalence in East Africa: Updating data for malaria stratification

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  • Victor A. Alegana
  • Peter M. Macharia
  • Samuel Muchiri
  • Eda Mumo
  • Elvis Oyugi
  • Alice Kamau
  • Frank Chacky
  • Sumaiyya Thawer
  • Fabrizio Molteni
  • Damian Rutazanna
  • Catherine Maiteki-Sebuguzi
  • Samuel Gonahasa
  • Abdisalan M. Noor
  • Robert W. Snow
  • Ruth Ashton (Editor)
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Article numbere0000014
<mark>Journal publication date</mark>7/12/2021
<mark>Journal</mark>PLOS Global Public Health
Issue number12
Volume1
Number of pages21
Publication StatusPublished
<mark>Original language</mark>English

Abstract

The High Burden High Impact (HBHI) strategy for malaria encourages countries to use multiple sources of available data to define the sub-national vulnerabilities to malaria risk, including parasite prevalence. Here, a modelled estimate of Plasmodium falciparum from an updated assembly of community parasite survey data in Kenya, mainland Tanzania, and Uganda is presented and used to provide a more contemporary understanding of the sub-national malaria prevalence stratification across the sub-region for 2019. Malaria prevalence data from surveys undertaken between January 2010 and June 2020 were assembled form each of the three countries. Bayesian spatiotemporal model-based approaches were used to interpolate space-time data at fine spatial resolution adjusting for population, environmental and ecological covariates across the three countries. A total of 18,940 time-space age-standardised and microscopy-converted surveys were assembled of which 14,170 (74.8%) were identified after 2017. The estimated national population-adjusted posterior mean parasite prevalence was 4.7% (95% Bayesian Credible Interval 2.6–36.9) in Kenya, 10.6% (3.4–39.2) in mainland Tanzania, and 9.5% (4.0–48.3) in Uganda. In 2019, more than 12.7 million people resided in communities where parasite prevalence was predicted ≥ 30%, including 6.4%, 12.1% and 6.3% of Kenya, mainland Tanzania and Uganda populations, respectively. Conversely, areas that supported very low parasite prevalence (<1%) were inhabited by approximately 46.2 million people across the sub-region, or 52.2%, 26.7% and 10.4% of Kenya, mainland Tanzania and Uganda populations, respectively. In conclusion, parasite prevalence represents one of several data metrics for disease stratification at national and sub-national levels. To increase the use of this metric for decision making, there is a need to integrate other data layers on mortality related to malaria, malaria vector composition, insecticide resistance and bionomic, malaria care-seeking behaviour and current levels of unmet need of malaria interventions.