Detecting temporal and spatial malaria patterns from first antenatal care visits
Arnau Pujol, Nanna Brokhattingen, Glória Matambisso, Henriques Mbeve, Pau Cisteró, Anna Escoda, Sónia Maculuve, Boaventura Cuna, Cardoso Melembe, Nelo Ndimande, Humberto Munguambe, Júlia Montañà, Lídia Nhamússua, Wilson Simone, Kevin K. A. Tetteh, Chris Drakeley, Benoît Gamain, Chetan E. Chitnis, Virander S. Chauhan, Llorenç Quintó, Arlindo Chidimatembue, Helena Martí-Soler, Beatriz Galatas, Caterina Guinovart, Francisco Saúte, Pedro Aíde, Eusébio Macete, Alfredo Mayor
Abstract
Pregnant women attending first antenatal care (ANC) visits represent a promising malaria surveillance target in Sub-Saharan Africa. We assessed the spatio-temporal relationship between malaria trends at ANC (n = 6471) and in children in the community (n = 3933) and at health facilities (n = 15,467) in southern Mozambique (2016-2019). ANC P. falciparum rates detected by quantitative polymerase chain reaction mirrored rates in children, regardless of gravidity and HIV status (Pearson correlation coefficient [PCC] > 0.8, χ²<1.1), with a 2-3 months lag. Only at rapid diagnostic test detection limits at moderate-to-high transmission, did multigravidae show lower rates than children (PCC = 0.61, 95%CI[-0.12-0.94]). Seroprevalence against the pregnancy-specific antigen VAR2CSA reflected declining malaria trends (PCC = 0.74, 95%CI[0.24-0.77]). 60% (9/15) of hotspots detected from health facility data (n = 6662) using a novel hotspot detector, EpiFRIenDs, were also identified with ANC data (n = 3616). Taken together, we show that ANC-based malaria surveillance offers contemporary information on temporal trends and geographic distribution of malaria burden in the community.