WHO, 2016. World Malaria Report 2016. Geneva, Switzerland: World Health Organization, 38–44.
WHO, 2014. World Malaria Report 2014. Geneva, Switzerland: World Health Organization, xii.
Zu Erbach-Schoenberg E et al. 2016. Dynamic denominators: the impact of seasonally varying population numbers on disease incidence estimates. Popul Health Metr 14: 35.
WHO, 2015. Guidelines for the Treatment of Malaria, 3rd edition. Geneva, Switzerland: World Health Organization.
Boyce RM, Reyes R, Matte M, Ntaro M, Mulogo E, Lin FC, Siedner MJ, 2016. Practical implications of the non-linear relationship between the test positivity rate and malaria incidence. PLoS One 11: e0152410.
WHO, 2012. Diseases Surveillance for Malaria Control: An Operational Manual. Geneva, Switzerland: World Health Organization.
Argaw MD, Woldegiorgis AGY, Abate DT, Abebe ME, 2016. Improved malaria case management in formal private sector through public private partnership in Ethiopia: retrospective descriptive study. Malar J 15: 352.
Githinji S, Noor AM, Malinga J, Macharia PM, Kiptui R, Omar A, Njagi K, Waqo E, Snow RW, 2016. A national health facility survey of malaria infection among febrile patients in Kenya, 2014. Malar J 15: 591.
Raouf S et al. 2017. Resurgence of malaria following discontinuation of indoor residual spraying of insecticide in an area of Uganda with previously high-transmission intensity. Clin Infect Dis 65: 453–460.
Sserwanga A et al. 2011. Improved malaria case management through the implementation of a health facility-based sentinel site surveillance system in Uganda. PLoS One 6: e16316.
Aregawi M et al. 2017. Effect of anti-malarial interventions on trends of malaria cases, hospital admissions and deaths, 2005–2015, Ghana. Malar J 16: 177.
Oguttu DW, Matovu JKB, Okumu DC, Ario AR, Okullo AE, Opigo J, Nankabirwa V, 2017. Rapid reduction of malaria following introduction of vector control interventions in Tororo District, Uganda: a descriptive study. Malar J 16: 227.
UMSP, 2016. UMSP: Malaria Reference Centres Surveillance Report. January 2016. Kampala, Uganda: Uganda Malaria Surveillance Project.
Bi Y, Hu W, Liu H, Xiao Y, Guo Y, Chen S, Zhao L, Tong S, 2012. Can slide positivity rates predict malaria transmission? Malar J 11: 117.
Okello PE, Van Bortel W, Byaruhanga AM, Correwyn A, Roelants P, Talisuna A, D’Alessandro U, Coosemans M, 2006. Variation in malaria transmission intensity in seven sites throughout Uganda. Am J Trop Med Hyg 75: 219–225.
Staedke SG et al. 2016. The impact of an intervention to improve malaria care in public health centers on health indicators of children in Tororo, Uganda (PRIME): a cluster-randomized trial. Am J Trop Med Hyg 95: 358–367.
Kamya MR et al. 2015. Malaria transmission, infection, and disease at three sites with varied transmission intensity in Uganda: implications for malaria control. Am J Trop Med Hyg 92: 903–912.
Mabaso ML, Craig M, Vounatsou P, Smith T, 2005. Towards empirical description of malaria seasonality in southern Africa: the example of Zimbabwe. Trop Med Int Health 10: 909–918.
Mabaso ML, Vounatsou P, Midzi S, Da Silva J, Smith T, 2006. Spatio-temporal analysis of the role of climate in inter-annual variation of malaria incidence in Zimbabwe. Int J Health Geogr 5: 20.
Doolan DL, Dobano C, Baird JK, 2009. Acquired immunity to malaria. Clin Microbiol Rev 22: 13–36.
Kigozi R et al. 2012. Indoor residual spraying of insecticide and malaria morbidity in a high transmission intensity area of Uganda. PLoS One 7: e42857.
Linard C, Gilbert M, Snow RW, Noor AM, Tatem AJ, 2012. Population distribution, settlement patterns and accessibility across Africa in 2010. PLoS One 7: e31743.
UBOS, 2016. The National Population and Housing Census 2014–Main Report. Kampala, Uganda: Uganda Bureau of Statistics.
Kwiecien R, Kopp-Schneider A, Blettner M, 2011. Concordance analysis: part 16 of a series on evaluation of scientific publications. Dtsch Arztebl Int 108: 515–521.
Kigozi R, Zinszer K, Mpimbaza A, Sserwanga A, Kigozi SP, Kamya M, 2016. Assessing temporal associations between environmental factors and malaria morbidity at varying transmission settings in Uganda. Malar J 15: 511.
Githinji S, Kigen S, Memusi D, Nyandigisi A, Wamari A, Muturi A, Jagoe G, Ziegler R, Snow RW, Zurovac D, 2014. Using mobile phone text messaging for malaria surveillance in rural Kenya. Malar J 13: 107.
Francis D, Gasasira A, Kigozi R, Kigozi S, Nasr S, Kamya MR, Dorsey G, 2012. Health facility-based malaria surveillance: the effects of age, area of residence and diagnostics on test positivity rates. Malar J 11: 229.
Amuge B, Wabwire-Mangen F, Puta C, Pariyo GW, Bakyaita N, Staedke S, Kamya M, Olico-Okui, 2004. Health-seeking behavior for malaria among child and adult headed households in Rakai district, Uganda. Afr Health Sci 4: 119–124.
Mbonye AK, Neema S, Magnussen P, 2006. Malaria in pregnancy, risk perceptions and care seeking practices among adolescents in Mukono district Uganda. Int J Adolesc Med Health 18: 561–573.
Muhumuza G, Mutesi C, Mutamba F, Ampuriire P, Nangai C, 2015. Acceptability and utilization of community health workers after the adoption of the integrated community case management policy in Kabarole district in Uganda. Health Syst Policy Res 2: 13.
Ndyomugyenyi R, Magnussen P, Clarke S, 2007. Malaria treatment-seeking behaviour and drug prescription practices in an area of low transmission in Uganda: implications for prevention and control. Trans R Soc Trop Med Hyg 101: 209–215.
Rutebemberwa E, Pariyo G, Peterson S, Tomson G, Kallander K, 2009. Utilization of public or private health care providers by febrile children after user fee removal in Uganda. Malar J 8: 45.
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Test positivity rate (TPR)—confirmed cases per 100 suspected cases tested, and test-confirmed malaria case rate (IR)—cases per 1,000 population, are common indicators used routinely for malaria surveillance. However, few studies have explored relationships between these indicators over time and space. We studied the relationship between these indicators in children aged < 11 years presenting with suspected malaria to the outpatient departments of level IV health centers in Nagongera, Kihihi, and Walukuba in Uganda from October 2011 to June 2016. We evaluated trends in indicators over time and space, and explored associations using multivariable regression models. Overall, 65,710 participants visited the three clinics. Pairwise comparisons of TPR and IR by month showed similar trends, particularly for TPRs < 50% and during low-transmission seasons, but by village, the relationship was complex. Village mean annual TPRs remained constant, whereas IRs drastically declined with increasing distance from the health center. Villages that were furthest away from the health centers (fourth quartile for distance) had significantly lower IRs than nearby villages (first quartile), with an incidence rate ratio of 0.40 in Nagongera (95% CI: 0.23–0.63; P = 0.001), 0.55 in Kihihi (0.40–0.75; P < 0.001), and 0.25 in Walukuba (0.12–0.51; P < 0.001). Regression analysis results emphasized a nonlinear (cubic) relationship between TPR and IR, after accounting for month, village, season, and demographic factors. Results show that the two indicators are highly relevant for monitoring malaria burden. However, interpretation differs with TPR primarily indicating demand for malaria treatment resources and IR indicating malaria risk among health facility catchment populations.
Financial support: We acknowledge, with gratitude, funding from the President’s Malaria Initiative, U.S. Agency for International Development under the terms of Interagency Agreement (1U51CK000117) with the CDC for the parent study and the Fogarty International Centers training grant (D43TW7375) for this substudy.
Availability of data and materials: The dataset used and/or analyzed during the present study are available from the corresponding author on reasonable request.
Authors’ addresses: Simon P. Kigozi and Rachel L. Pullan, Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom, E-mails: skigozi@yahoo.com and rachel.pullan@lshtm.ac.uk. Ruth N. Kigozi, USAID’s Malaria Action Program for Districts, Kampala, Uganda, E-mail: kigoziruth@gmail.com. Asadu Sserwanga, Infectious Diseases Research Collaboration, Kampala, Uganda, E-mail: asserwanga@idrc-uganda.org. Joaniter I. Nankabirwa and Moses R. Kamya, School of Medicine, Makerere University College of Health Sciences, Mulago Hospital Complex, Kampala, Uganda, E-mails: jnankabirwa@yahoo.co.uk and mkamya@infocom.co.ug. Sarah G. Staedke, Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom, E-mail: sarah.staedke@lshtm.ac.uk.
WHO, 2016. World Malaria Report 2016. Geneva, Switzerland: World Health Organization, 38–44.
WHO, 2014. World Malaria Report 2014. Geneva, Switzerland: World Health Organization, xii.
Zu Erbach-Schoenberg E et al. 2016. Dynamic denominators: the impact of seasonally varying population numbers on disease incidence estimates. Popul Health Metr 14: 35.
WHO, 2015. Guidelines for the Treatment of Malaria, 3rd edition. Geneva, Switzerland: World Health Organization.
Boyce RM, Reyes R, Matte M, Ntaro M, Mulogo E, Lin FC, Siedner MJ, 2016. Practical implications of the non-linear relationship between the test positivity rate and malaria incidence. PLoS One 11: e0152410.
WHO, 2012. Diseases Surveillance for Malaria Control: An Operational Manual. Geneva, Switzerland: World Health Organization.
Argaw MD, Woldegiorgis AGY, Abate DT, Abebe ME, 2016. Improved malaria case management in formal private sector through public private partnership in Ethiopia: retrospective descriptive study. Malar J 15: 352.
Githinji S, Noor AM, Malinga J, Macharia PM, Kiptui R, Omar A, Njagi K, Waqo E, Snow RW, 2016. A national health facility survey of malaria infection among febrile patients in Kenya, 2014. Malar J 15: 591.
Raouf S et al. 2017. Resurgence of malaria following discontinuation of indoor residual spraying of insecticide in an area of Uganda with previously high-transmission intensity. Clin Infect Dis 65: 453–460.
Sserwanga A et al. 2011. Improved malaria case management through the implementation of a health facility-based sentinel site surveillance system in Uganda. PLoS One 6: e16316.
Aregawi M et al. 2017. Effect of anti-malarial interventions on trends of malaria cases, hospital admissions and deaths, 2005–2015, Ghana. Malar J 16: 177.
Oguttu DW, Matovu JKB, Okumu DC, Ario AR, Okullo AE, Opigo J, Nankabirwa V, 2017. Rapid reduction of malaria following introduction of vector control interventions in Tororo District, Uganda: a descriptive study. Malar J 16: 227.
UMSP, 2016. UMSP: Malaria Reference Centres Surveillance Report. January 2016. Kampala, Uganda: Uganda Malaria Surveillance Project.
Bi Y, Hu W, Liu H, Xiao Y, Guo Y, Chen S, Zhao L, Tong S, 2012. Can slide positivity rates predict malaria transmission? Malar J 11: 117.
Okello PE, Van Bortel W, Byaruhanga AM, Correwyn A, Roelants P, Talisuna A, D’Alessandro U, Coosemans M, 2006. Variation in malaria transmission intensity in seven sites throughout Uganda. Am J Trop Med Hyg 75: 219–225.
Staedke SG et al. 2016. The impact of an intervention to improve malaria care in public health centers on health indicators of children in Tororo, Uganda (PRIME): a cluster-randomized trial. Am J Trop Med Hyg 95: 358–367.
Kamya MR et al. 2015. Malaria transmission, infection, and disease at three sites with varied transmission intensity in Uganda: implications for malaria control. Am J Trop Med Hyg 92: 903–912.
Mabaso ML, Craig M, Vounatsou P, Smith T, 2005. Towards empirical description of malaria seasonality in southern Africa: the example of Zimbabwe. Trop Med Int Health 10: 909–918.
Mabaso ML, Vounatsou P, Midzi S, Da Silva J, Smith T, 2006. Spatio-temporal analysis of the role of climate in inter-annual variation of malaria incidence in Zimbabwe. Int J Health Geogr 5: 20.
Doolan DL, Dobano C, Baird JK, 2009. Acquired immunity to malaria. Clin Microbiol Rev 22: 13–36.
Kigozi R et al. 2012. Indoor residual spraying of insecticide and malaria morbidity in a high transmission intensity area of Uganda. PLoS One 7: e42857.
Linard C, Gilbert M, Snow RW, Noor AM, Tatem AJ, 2012. Population distribution, settlement patterns and accessibility across Africa in 2010. PLoS One 7: e31743.
UBOS, 2016. The National Population and Housing Census 2014–Main Report. Kampala, Uganda: Uganda Bureau of Statistics.
Kwiecien R, Kopp-Schneider A, Blettner M, 2011. Concordance analysis: part 16 of a series on evaluation of scientific publications. Dtsch Arztebl Int 108: 515–521.
Kigozi R, Zinszer K, Mpimbaza A, Sserwanga A, Kigozi SP, Kamya M, 2016. Assessing temporal associations between environmental factors and malaria morbidity at varying transmission settings in Uganda. Malar J 15: 511.
Githinji S, Kigen S, Memusi D, Nyandigisi A, Wamari A, Muturi A, Jagoe G, Ziegler R, Snow RW, Zurovac D, 2014. Using mobile phone text messaging for malaria surveillance in rural Kenya. Malar J 13: 107.
Francis D, Gasasira A, Kigozi R, Kigozi S, Nasr S, Kamya MR, Dorsey G, 2012. Health facility-based malaria surveillance: the effects of age, area of residence and diagnostics on test positivity rates. Malar J 11: 229.
Amuge B, Wabwire-Mangen F, Puta C, Pariyo GW, Bakyaita N, Staedke S, Kamya M, Olico-Okui, 2004. Health-seeking behavior for malaria among child and adult headed households in Rakai district, Uganda. Afr Health Sci 4: 119–124.
Mbonye AK, Neema S, Magnussen P, 2006. Malaria in pregnancy, risk perceptions and care seeking practices among adolescents in Mukono district Uganda. Int J Adolesc Med Health 18: 561–573.
Muhumuza G, Mutesi C, Mutamba F, Ampuriire P, Nangai C, 2015. Acceptability and utilization of community health workers after the adoption of the integrated community case management policy in Kabarole district in Uganda. Health Syst Policy Res 2: 13.
Ndyomugyenyi R, Magnussen P, Clarke S, 2007. Malaria treatment-seeking behaviour and drug prescription practices in an area of low transmission in Uganda: implications for prevention and control. Trans R Soc Trop Med Hyg 101: 209–215.
Rutebemberwa E, Pariyo G, Peterson S, Tomson G, Kallander K, 2009. Utilization of public or private health care providers by febrile children after user fee removal in Uganda. Malar J 8: 45.
Past two years | Past Year | Past 30 Days | |
---|---|---|---|
Abstract Views | 1430 | 1230 | 894 |
Full Text Views | 1472 | 18 | 6 |
PDF Downloads | 426 | 17 | 4 |