Spatio-temporal modelling of routine health facility data for malaria risk micro-stratification in mainland Tanzania

As malaria transmission declines, the need to monitor the heterogeneity of malaria risk at finer scales becomes critical to guide community-based targeted interventions. Although routine health facility (HF) data can provide epidemiological evidence at high spatial and temporal resolution, its incomplete nature of information can result in lower administrative units without empirical data. To overcome geographic sparsity of data and its representativeness, geo-spatial models can leverage routine information to predict risk in un-represented areas as well as estimate uncertainty of predictions. Here, a Bayesian spatio-temporal model was applied on malaria test positivity rate (TPR) data for the period 2017-2019 to predict risks at the ward level, the lowest decision-making unit in mainland Tanzania. To quantify the associated uncertainty, the probability of malaria TPR exceeding programmatic threshold was estimated. Results showed a marked spatial heterogeneity in malaria TPR across wards. 17.7 million people resided in areas where malaria TPR was high (>/= 30; 90% certainty) in the North-West and South-East parts of Tanzania. Approximately 11.7 million people lived in areas where malaria TPR was very low (< 5%; 90% certainty). HF data can be used to identify different epidemiological strata and guide malaria interventions at micro-planning units in Tanzania. These data, however, are imperfect in many settings in Africa and often require application of geo-spatial modelling techniques for estimation

The use of routine health facility data for micro-stratification of malaria risk in mainland Tanzania

BACKGROUND: Current efforts to estimate the spatially diverse malaria burden in malaria-endemic countries largely involve the use of epidemiological modelling methods for describing temporal and spatial heterogeneity using sparse interpolated prevalence data from periodic cross-sectional surveys. However, more malaria-endemic countries are beginning to consider local routine data for this purpose. Nevertheless, routine information from health facilities (HFs) remains widely under-utilized despite improved data quality, including increased access to diagnostic testing and the adoption of the electronic District Health Information System (DHIS2). This paper describes the process undertaken in mainland Tanzania using routine data to develop a high-resolution, micro-stratification risk map to guide future malaria control efforts. METHODS: Combinations of various routine malariometric indicators collected from 7098 HFs were assembled across 3065 wards of mainland Tanzania for the period 2017-2019. The reported council-level prevalence classification in school children aged 5-16 years (PfPR(5-16)) was used as a benchmark to define four malaria risk groups. These groups were subsequently used to derive cut-offs for the routine indicators by minimizing misclassifications and maximizing overall agreement. The derived-cutoffs were converted into numbered scores and summed across the three indicators to allocate wards into their overall risk stratum. RESULTS: Of 3065 wards, 353 were assigned to the very low strata (10.5% of the total ward population), 717 to the low strata (28.6% of the population), 525 to the moderate strata (16.2% of the population), and 1470 to the high strata (39.8% of the population). The resulting micro-stratification revealed malaria risk heterogeneity within 80 councils and identified wards that would benefit from community-level focal interventions, such as community-case management, indoor residual spraying and larviciding. CONCLUSION: The micro-stratification approach employed is simple and pragmatic, with potential to be easily adopted by the malaria programme in Tanzania. It makes use of available routine data that are rich in spatial resolution and that can be readily accessed allowing for a stratification of malaria risk below the council level. Such a framework is optimal for supporting evidence-based, decentralized malaria control planning, thereby improving the effectiveness and allocation efficiency of malaria control interventions

Improving access to care and community health in Haiti with optimized community health worker placement

The national deployment of polyvalent community health workers (CHWs) is a constitutive part of the strategy initiated by the Ministry of Health to accelerate efforts towards universal health coverage in Haiti. Its implementation requires the planning of future recruitment and deployment activities for which mathematical modelling tools can provide useful support by exploring optimised placement scenarios based on access to care and population distribution. We combined existing gridded estimates of population and travel times with optimisation methods to derive theoretical CHW geographical placement scenarios including constraints on walking time and the number of people served per CHW. Four national-scale scenarios that align with total numbers of existing CHWs and that ensure that the walking time for each CHW does not exceed a predefined threshold are compared. The first scenario accounts for population distribution in rural and urban areas only, while the other three also incorporate in different ways the proximity of existing health centres. Comparing these scenarios to the current distribution, insufficient number of CHWs is systematically identified in several departments and gaps in access to health care are identified within all departments. These results highlight current suboptimal distribution of CHWs and emphasize the need to consider an optimal (re-)allocation

Acceptability, feasibility, drug safety, and effectiveness of a pilot mass drug administration with a single round of sulfadoxine-pyrimethamine plus primaquine and indoor residual spraying in communities with malaria transmission in Haiti, 2018

For a malaria elimination strategy, Haiti's National Malaria Control Program piloted a mass drug administration (MDA) with indoor residual spraying (IRS) in 12 high-transmission areas across five communes after implementing community case management and strengthened surveillance. The MDA distributed sulfadoxine-pyrimethamine and single low-dose primaquine to eligible residents during house visits. The IRS campaign applied pirimiphos-methyl insecticide on walls of eligible houses. Pre- and post-campaign cross-sectional surveys were conducted to assess acceptability, feasibility, drug safety, and effectiveness of the combined interventions. Stated acceptability for MDA before the campaign was 99.2%; MDA coverage estimated at 10 weeks post-campaign was 89.6%. Similarly, stated acceptability of IRS at baseline was 99.9%; however, household IRS coverage was 48.9% because of the high number of ineligible houses. Effectiveness measured by Plasmodium falciparum prevalence at baseline and 10 weeks post-campaign were similar: 1.31% versus 1.43%, respectively. Prevalence of serological markers were similar at 10 weeks post-campaign compared with baseline, and increased at 6 months. No severe adverse events associated with the MDA were identified in the pilot; there were severe adverse events in a separate, subsequent campaign. Both MDA and IRS are acceptable and feasible interventions in Haiti. Although a significant impact of a single round of MDA/IRS on malaria transmission was not found using a standard pre- and post-intervention comparison, it is possible there was blunting of the peak transmission. Seasonal malaria transmission patterns, suboptimal IRS coverage, and low baseline parasitemia may have limited the effectiveness or the ability to measure effectiveness

Four-quadrant silicon and silicon carbide photodiodes for beam position monitor applications: Electrical characterization and electron irradiation effects

Silicon photodiodes are very useful devices as X-ray beam monitors in synchrotron radiation beamlines, as well as other astronomy and space applications. Owing to their lower susceptibility to variable temperature and illumination conditions, there is also special interest in silicon carbide devices for some of these applications. Moreover, radiation hardness of the involved technologies is a major concern for high-energy physics and space applications. This work presents four-quadrant photodiodes produced on ultrathin (10 μm) and bulk Si, as well as on SiC epilayer substrates. An extensive electrical characterization has been carried out by using current-voltage (I-V) and capacitance-voltage (C-V) techniques. The impact of different temperature (from -50C to 175C) and visible light conditions on the electrical characteristics of the devices has been evaluated. Radiation effects caused by 2 MeV electron irradiation up to 1×1014, 1×1015 and 1×1016 e/cm2 fluences have been studied. Special attention has been devoted to the study of charge build-up in diode interquadrant isolation, as well as its impact on interquadrant resistance. The study of these electrical properties and its radiation-induced degradation should be taken into account for device applications.Peer reviewe

Estimating malaria transmission intensity from Plasmodium falciparum serological data using antibody density models.

BACKGROUND: Serological data are increasingly being used to monitor malaria transmission intensity and have been demonstrated to be particularly useful in areas of low transmission where traditional measures such as EIR and parasite prevalence are limited. The seroconversion rate (SCR) is usually estimated using catalytic models in which the measured antibody levels are used to categorize individuals as seropositive or seronegative. One limitation of this approach is the requirement to impose a fixed cut-off to distinguish seropositive and negative individuals. Furthermore, the continuous variation in antibody levels is ignored thereby potentially reducing the precision of the estimate. METHODS: An age-specific density model which mimics antibody acquisition and loss was developed to make full use of the information provided by serological measures of antibody levels. This was fitted to blood-stage antibody density data from 12 villages at varying transmission intensity in Northern Tanzania to estimate the exposure rate as an alternative measure of transmission intensity. RESULTS: The results show a high correlation between the exposure rate estimates obtained and the estimated SCR obtained from a catalytic model (r = 0.95) and with two derived measures of EIR (r = 0.74 and r = 0.81). Estimates of exposure rate obtained with the density model were also more precise than those derived from catalytic models. CONCLUSION: This approach, if validated across different epidemiological settings, could be a useful alternative framework for quantifying transmission intensity, which makes more complete use of serological data

Larval life history traits and larval growth of Gnathodentex aurolineatus (Lethrinidae) before and after settlement in a sandy bay of Reunion Island (SW Indian Ocean)

Larval life history traits and larval growth of Gnathodentex aurolineatus (Lethrinidae) before and after settlment in a sandy bay of Reunion Island (SW Indian Ocean). The larval history of Gnathodentex aurolineatus (Lethrinidae), a widespread species of the coral reefs in Reunion Island (SW Indian Ocean), was revealed by otolith analysis. Pairs of otoliths from 108 fishes were collected during a peak settlement in Saint-Paul Bay. Standard length (SL) ranged from 62.5 to 70.7 mm and total length from 73.7 to 85.5 mm. Morphometric analysis of both all fishes and their otoliths, suggested that the.-samples came from a single cohort. Transverse sections of sagitta (embedded in thermoplastic glue (Crystal Bond) and polished) were analysed. Daily periodicity of increments formation in otoliths was validated by alizarin red labelling. Daily increments were observed under a light microscope and counted to estimate age, age at settlement, larval life duration and laying, hatching and settlement dates. A settlement mark was visible on otolith sections. Fish age ranged between 55.2 and 59.4 days. The pelagic larval stage was estimated to 40.0 +/- 2.5 days. Laying dates were estimated to occur in December 2002, between the 23(rd) and the 27(th), a few days before the new moon period. Hatching dates were estimated to occur between December 24 and 28, and the first feeding dates between December 26 and 30. Colonization took place in January 2003, between the 15(th) and the 19(th) , during the full moon period. The back-calculated laying size was comprised between 0.83 and 2.41 mm SL. The back-calculated settlement size found in this study in the bay (between 44.60 and 50.44 min SL) was lower than the settlement size found in the lagoon zone (80 min). Width increments on otolith sections were measured to establish otolith growth. Otolith growth (mean: 1.1 +/- 0.1 mm.d(-1)) was divided in two parts, showing significantly different growth rates. A first phase of rapid growth 1.4 +/- 0.1 mm.d(-1) during the pelagic stage, followed by a slowed down growth 0.7 +/- 0.2 mm.d(-1) after settlement. The analysis of larval life events in relation to the current context in Indian Ocean Suggests that recruits (i) come from Reunion Island or Mauritius Island and (ii) colonize the sandy and protected bay of Saint-Paul as an intermediate zone, before their resettlement on coral reef

The usefulness of otolith chemistry to determine the life history of the honeycomb grouper around Reunion Island (SW Indian Ocean)

International audienceDue to the relative geographical isolation of Reunion Island the grouper Epinephelus merra is assumed to be self-recruited but almost nothing is known about its larval history. We used elemental composition of the otoliths (Ba, Sr, Mn, Mg, Na) of fifty-eight one year-old groupers collected from four main coral reefs on the west coast of Reunion Island, to determine environmental variations during their early life history. Hierarchical clustering analysis of the otolith chemical composition of core and early larval phase, allowed the identification of three groups of larvae. Larvae from the first group (cluster 1) were born and dispersed in Ba-enriched water bodies, while the second and third groups included larvae that had crossed Ba-poor water masses. Larvae of group 1 were primarily found in the southern sector (74%) decreasing northward, while group 3 were more abundant in the northern sector (56%) and cluster 2 showed a scattered distribution. Such opposite spatial distributions might suggest that clusters 1 and 3 originated from opposite dispersal kernels, south and north respectively. It is possible however that larvae from both groups came from the same spawning ground but represented different cohorts that experienced changing geochemical conditions either at the spawning site or within the surrounding pelagic environment, over the course of the breeding season. Both scenarios on the origin and dispersion may thus suggest significant influence of hydrographic features causing or preventing larvae from becoming displaced far from their natal area. © 2016 Elsevier B.V

A methodology for malaria programme impact evaluation

This document describes a methodology for continual assessment of the impact of malaria interventions, and the efficiency of the malaria programme. The methodology is designed to be implemented recurrently on a cycle of 2–5 years, with the involvement of stakeholders, including National Malaria Control Programmes, development partners and other organizations active in the programme. Their participation should inform the impact and efficiency assessment, so that it is linked to subsequent decision making defining the nature and scope of malaria control interventions. The methodology is designed in a modular way, providing some flexibility with regard to which elements are implemented at any given time. Some modules require technical capabilities usually not available in a regular monitoring and evaluation (M&amp;E) team, and will require contributions from other national and/or international partners.</jats:p