Malaria transmission, burden and control measures in school-aged children and adolescents: An experience of school-based surveillance in mainland Tanzania
PhD summary
Global progress for reducing malaria incidence by at least 90% and achieve elimination in 35 countries by 2030, has been stalling. This calls for innovative approaches to combat malaria transmission and monitoring set goals for intervention impacts. Studied have shown the spectrum of malaria endemicity, particularly in areas of higher transmission are associated with a much higher concentration of burden within younger children. This might be due to acquisition of immunity as children are repeatedly exposed to the parasite in these settings. However, as transmission falls, the proportion of older children with higher burden of malaria increases, calling for the control strategies focused towards both transmission and burden reduction. To date, limited research has been dedicated to understanding where, when and how school-aged children should be targeted. This is in partly due to a lack of data as most of the malaria prevalence surveys often only focuses on children under-five. Hence, this research work is developed within the scope of an established routine School Malaria Surveillance initiative implemented in Tanzania, titled “School Malaria Parasitaemia Survey (SMPS)”. The surveillance has been implemented in primary schools’ framework, routinely after every two years in 2015, 2017, 2019 and 2021 and covers over 750 unique public primary schools, 246,790 school children, from all 26 regions and 184 councils of the mainland Tanzania. This proposed research work will utilize SMPSs data to provide information on the magnitude, spatial heterogeneity and temporal patterns of malaria prevalence; coverage, access and utilization of control interventions and their impact on malaria infection. Given that the regions and councils of Tanzania encompass much of the endemicity spectrum seen across Africa (i.e., holoendemic to near-elimination) these data provide a unique opportunity to characterise the risk of malaria in school-aged children, describe how the risk varies by endemicity (both present and historical) and the extent to which school-based intervention can effectively target malaria burden and transmission. At the end of the day, this research work will deliver an evidence-based guidance on the use of school-based surveillance for strategic malaria control to accelerate malaria elimination targets nationally and globally.