How useful are malaria risk maps at the country level? Perceptions of decision-makers in Kenya, Malawi and the Democrati
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Malaria Journal Open Access
RESEARCH
How useful are malaria risk maps at the country level? Perceptions of decision‑makers in Kenya, Malawi and the Democratic Republic of Congo Ludovica Ghilardi1* , George Okello5, Linda Nyondo‑Mipando9, Chawanangwa Mahebere Chirambo9, Fathy Malongo2, Jenna Hoyt1, Jieun Lee7, Yovitha Sedekia8, Justin Parkhurst4, Jo Lines1, Robert W. Snow5,6, Caroline A. Lynch3 and Jayne Webster1
Abstract Background: Declining malaria prevalence and pressure on external funding have increased the need for efficiency in malaria control in sub-Saharan Africa (SSA). Modelled Plasmodium falciparum parasite rate (PfPR) maps are increas‑ ingly becoming available and provide information on the epidemiological situation of countries. However, how these maps are understood or used for national malaria planning is rarely explored. In this study, the practices and percep‑ tions of national decision-makers on the utility of malaria risk maps, showing prevalence of parasitaemia or incidence of illness, was investigated. Methods: A document review of recent National Malaria Strategic Plans was combined with 64 in-depth interviews with stakeholders in Kenya, Malawi and the Democratic Republic of Congo (DRC). The document review focused on the type of epidemiological maps included and their use in prioritising and targeting interventions. Interviews (14 Kenya, 17 Malawi, 27 DRC, 6 global level) explored drivers of stakeholder perceptions of the utility, value and limita‑ tions of malaria risk maps. Results: Three different types of maps were used to show malaria epidemiological strata: malaria prevalence using a PfPR modelled map (Kenya); malaria incidence using routine health system data (Malawi); and malaria prevalence using data from the most recent Demographic and Health Survey (DRC). In Kenya the map was used to target pre‑ ventative interventions, including long-lasting insecticide-treated nets (LLINs) and intermittent preventive treatment in pregnancy (IPTp), whilst in Malawi and DRC the maps were used to target in-door residual spraying (IRS) and LLINs distributions in schools. Maps were also used for operational planning, supply quantification, financial justification and advocacy. Findings from the interviews suggested that decision-makers lacked trust in the modelled PfPR maps when based on only a few empirical data points (Malawi and DRC). Conclusions: Maps were generally used to identify areas with high prevalence in order to implement specific inter‑ ventions. Despite the availability of national level modelled PfPR maps in all three countries, they were only used in one country. Perceived utility of malaria risk maps was associated with the epidemiological structure of the country
*Correspondence: [email protected] 1 Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK Full list of author information is available at the end of the article © The Author(s) 2020. This article is licensed under a Creative Commons Attribution 4.0 International Licen
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