Malar J

BackgroundRecent malaria control efforts in mainland Tanzania have led to progressive changes in the prevalence of malaria infection in children, from 18.1% (2008) to 7.3% (2017). As the landscape of malaria transmission changes, a sub-national stratification becomes crucial for optimized cost-effective implementation of interventions. This paper describes the processes, data and outputs of the approach used to produce a simplified, pragmatic malaria risk stratification of 184 councils in mainland Tanzania.MethodsAssemblies of annual parasite incidence and fever test positivity rate for the period 2016\u20132017 as well as confirmed malaria incidence and malaria positivity in pregnant women for the period 2015\u20132017 were obtained from routine district health information software. In addition, parasite prevalence in school children (PfPR5to16) were obtained from the two latest biennial council representative school malaria parasitaemia surveys, 2014\u20132015 and 2017. The PfPR5to16 served as a guide to set appropriate cut-offs for the other indicators. For each indicator, the maximum value from the past 3\ua0years was used to allocate councils to one of four risk groups: very low (<\u20091%PfPR5to16), low (1 12\u2009<\u20095%PfPR5to16), moderate (5 12\u2009<\u200930%PfPR5to16) and high ( 65\u200930%PfPR5to16). Scores were assigned to each risk group per indicator per council and the total score was used to determine the overall risk strata of all councils.ResultsOut of 184 councils, 28 were in the very low stratum (12% of the population), 34 in the low stratum (28% of population), 49 in the moderate stratum (23% of population) and 73 in the high stratum (37% of population). Geographically, most of the councils in the low and very low strata were situated in the central corridor running from the north-east to south-west parts of the country, whilst the areas in the moderate to high strata were situated in the north-west and south-east regions.ConclusionA stratification approach based on multiple routine and survey malaria information was developed. This pragmatic approach can be rapidly reproduced without the use of sophisticated statistical methods, hence, lies within the scope of national malaria programmes across Africa.-/NETCELL Project - Swiss TPH, Swiss Agency for Development and Cooperation/-/NETCELL Project - Swiss TPH, Swiss Agency for Development and Cooperation/-/Global Fund to Fight Aids, Tuberculosis and Malaria (GFATM) and the Swiss Tropical and Public Health Institute/-/Global Fund to Fight Aids, Tuberculosis and Malaria (GFATM) and the Swiss Tropical and Public Health Institute/103602/WT_/Wellcome Trust/United Kingdom212176/WT_/Wellcome Trust/United Kingdom203155/Department for International Development/2020-05-08T00:00:00Z32384923PMC7206674779