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Mapping malaria incidence using routine health facility surveillance data in Uganda

Epstein, Adrienne, Namuganga, Jane Frances, Nabende, Isaiah, Kamya, Emmanuel Victor, Kamya, Moses R, Dorsey, Grant, Sturrock, Hugh, Bhatt, Samir, Rodríguez-Barraquer, Isabel and Greenhouse, Bryan (2023) 'Mapping malaria incidence using routine health facility surveillance data in Uganda'. BMJ Global Health, Vol 8, Issue 5, e011137.

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Abstract

Introduction
Maps of malaria risk are important tools for allocating resources and tracking progress. Most maps rely on cross-sectional surveys of parasite prevalence, but health facilities represent an underused and powerful data source. We aimed to model and map malaria incidence using health facility data in Uganda.

Methods
Using 24 months (2019-2020) of individual-level outpatient data collected from 74 surveillance health facilities located in 41 districts across Uganda (n=445 648 laboratory-confirmed cases), we estimated monthly malaria incidence for parishes within facility catchment areas (n=310) by estimating care-seeking population denominators. We fit spatio-temporal models to the incidence estimates to predict incidence rates for the rest of Uganda, informed by environmental, sociodemographic and intervention variables. We mapped estimated malaria incidence and its uncertainty at the parish level and compared estimates to other metrics of malaria. To quantify the impact that indoor residual spraying (IRS) may have had, we modelled counterfactual scenarios of malaria incidence in the absence of IRS.

Results
Over 4567 parish-months, malaria incidence averaged 705 cases per 1000 person-years. Maps indicated high burden in the north and northeast of Uganda, with lower incidence in the districts receiving IRS. District-level estimates of cases correlated with cases reported by the Ministry of Health (Spearman’s r=0.68, p<0.0001), but were considerably higher (40 166 418 cases estimated compared with 27 707 794 cases reported), indicating the potential for underreporting by the routine surveillance system. Modelling of counterfactual scenarios suggest that approximately 6.2 million cases were averted due to IRS across the study period in the 14 districts receiving IRS (estimated population 8 381 223).

Conclusion
Outpatient information routinely collected by health systems can be a valuable source of data for mapping malaria burden. National Malaria Control Programmes may consider investing in robust surveillance systems within public health facilities as a low-cost, high benefit tool to identify vulnerable regions and track the impact of interventions.

Item Type: Article
Subjects: WC Communicable Diseases > WC 20 Research (General)
WC Communicable Diseases > Tropical and Parasitic Diseases > WC 750 Malaria
Repository link:
Item titleItem URI
Dataset for the article: Mapping malaria incidence using routine health facility surveillance data in Ugandahttps://archive.lstmed.ac.uk/id/eprint/22892
Faculty: Department: Biological Sciences > Vector Biology Department
Digital Object Identifer (DOI): https://doi.org/10.1136/bmjgh-2022-011137
SWORD Depositor: JISC Pubrouter
Depositing User: JISC Pubrouter
Date Deposited: 30 May 2023 08:40
Last Modified: 08 Aug 2023 14:28
URI: https://archive.lstmed.ac.uk/id/eprint/22564

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