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The relationship between facility-based malaria test positivity rate and community-based parasite prevalence
Alice Kamau1,2, Grace Mtanje1, Christine Mataza1,3
1KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.
Plos One
|October 7, 2020
Summary
Routine health facility data can help define malaria risk. Test positivity rate (TPR) thresholds of over 49% indicate high malaria parasite prevalence (PR), while below 40% suggests low PR.
Area of Science:
- Epidemiology
- Public Health
- Infectious Disease Control
Background:
- Malaria surveillance is crucial for control in Africa.
- The utility of routine health facility data for community malaria risk assessment is unclear.
Purpose of the Study:
- To evaluate the relationship between test positivity rate (TPR) from health facilities and community parasite prevalence (PR).
- To determine if TPR can effectively predict malaria transmission intensity at community levels.
Main Methods:
- Cross-sectional surveys and fever surveillance data were collected over 12 months in Kilifi county, Kenya.
- Regression models explored the relationship between TPR and community PR across different age groups.
- TPR cut-offs were analyzed for predicting low (PR <5%) and high (PR ≥30%) malaria transmission.
Main Results:
- A total of 12,143 out of 28,134 febrile patients tested positive for malaria (43.2%).
- The overall community parasite prevalence was 9.9%.
- A TPR ≥49% corresponded to ≥30% PR, and TPR <40% corresponded to <5% PR, with a polynomial model best fitting the data.
Conclusions:
- A non-linear relationship exists between TPR and PR, significant for malaria surveillance, especially at transmission extremes.
- Further research with larger, diverse datasets is needed to validate TPR as a replacement for community PR in malaria control programs.
