Malaria is an acute febrile illness caused by a parasitic

infection transmitted by Anopheles mosquitoes. Human malaria is caused by five

different Plasmodium parasites, with P. falciparum being the predominant

species in sub-Saharan Africa (SSA) [1]. Malaria burden has a marked spatial

heterogeneity with endemicity varying across and within countries. Malaria risk

in endemic areas differs due to various factors, including the environment,

human behavior, vector ecology, health system, and country socio-economics. The

WHO Global technical strategy for malaria 2016-2030 suggests that malaria

intervention strategies should be tailored to account for the marked

heterogeneity that characterizes malaria risk within an endemic country. The

implementation of the same intervention(s) across a whole country could waste

resources and reduce effectiveness of interventions. Thus, countries should

target interventions and approaches based on a stratification of malaria burden

using data describing malaria incidence trends, vector and parasite

characteristics, human behavior, and environmental factors. 

Given the importance of improving intervention al

and their effectiveness, malaria stratification is key to malaria control and

elimination programming, with countries able to routinely analyze their data

and stratify malaria at subnational level.

ObjectivesThe objective of this scoping review is to map and summarize

different analytical approaches for malaria stratification. To our knowledge,

such review has not been conducted. A preliminary search for existing scoping

and systematic reviews on the topic was conducted on November 15, 2023, using

PubMed and no similar reviews were found. We will follow the PRISMA-ScR

(Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension

for Scoping Reviews) to conduct and report this scoping review [2].

A systematic search of PubMed was conducted on January 2,

2024, to identify studies and analyses that had used routine surveillance and

health management information systems data to assess the effectiveness of

malaria interventions. A detailed search strategy was designed and piloted to

identify the optimal combination of keywords used.

We examined the available electronic databases using

combination searches of the following Boolean terms: “Malaria” AND “Stratification”.

Other key terms for such as "epidemiology”, “heterogeneity” or

“information systems” were not included in the search strategy to have a more

comprehensive search and will be used during abstract and full text screening.

All identified studies will be imported into Rayyan, a

systematic review management software, to screen (title, abstract, and full

text) and manage the results of the search. Two reviewers will independently

assess the titles and abstracts of the included articles based on the inclusion

criteria. In the event of discordance between the two reviewers, a third

reviewer will review the titles and abstracts and will come to a final decision.

From the included articles, the two reviewers will identify relevant

publications by reviewing the full text. Any discordance will again be resolved

by a third reviewer. A PRISMA flow diagram will be used to report final numbers

of articles that are included and excluded at each stage.

No exclusion criteria were applied in terms of time period or language.

From the included articles, each reviewer will work

independently to extract data from the articles following a pre-specified

extraction sheet. The following data will be extracted from each paper into an

MS Excel spreadsheet: (1) author; (2) year of publication; (3) geography; (4)

study design; (5) study period / time period covered; (6) approach to stratification;

(7) data platform for stratification; (8) indicator variables used for

stratification; (10) key findings; and (11) items from the Template for

Intervention Description and Replication (TIDieR) checklist. TIDieR is a

12-item checklist that includes the brief name, why, what (materials), what

(procedure), who provided, how, where, when and how much, tailoring,

modifications, how well (planned), how well (actual) of a program.

The proposed scoping review will outline the approaches that

have been used for malaria stratification. The scoping review does not involve

data on human subjects and ethical approval is not required.