Geostatistical modeling of malaria endemicity using serological indicators of exposure collected through school surveys

Am J Trop Med Hyg. 2015 Jul;93(1):168-177. doi: 10.4269/ajtmh.14-0620. Epub 2015 May 11.


Ethiopia has a diverse ecology and geography resulting in spatial and temporal variation in malaria transmission. Evidence-based strategies are thus needed to monitor transmission intensity and target interventions. A purposive selection of dried blood spots collected during cross-sectional school-based surveys in Oromia Regional State, Ethiopia, were tested for presence of antibodies against Plasmodium falciparum and P. vivax antigens. Spatially explicit binomial models of seroprevalence were created for each species using a Bayesian framework, and used to predict seroprevalence at 5 km resolution across Oromia. School seroprevalence showed a wider prevalence range than microscopy for both P. falciparum (0-50% versus 0-12.7%) and P. vivax (0-53.7% versus 0-4.5%), respectively. The P. falciparum model incorporated environmental predictors and spatial random effects, while P. vivax seroprevalence first-order trends were not adequately explained by environmental variables, and a spatial smoothing model was developed. This is the first demonstration of serological indicators being used to detect large-scale heterogeneity in malaria transmission using samples from cross-sectional school-based surveys. The findings support the incorporation of serological indicators into periodic large-scale surveillance such as Malaria Indicator Surveys, and with particular utility for low transmission and elimination settings.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Antibodies, Protozoan / immunology*
  • Antigens, Protozoan / immunology
  • Bayes Theorem
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Endemic Diseases / statistics & numerical data*
  • Enzyme-Linked Immunosorbent Assay
  • Ethiopia / epidemiology
  • Humans
  • Malaria, Falciparum / epidemiology*
  • Malaria, Falciparum / immunology
  • Malaria, Vivax / epidemiology*
  • Malaria, Vivax / immunology
  • Male
  • Membrane Proteins / immunology
  • Merozoite Surface Protein 1 / immunology
  • Multivariate Analysis
  • Plasmodium falciparum / immunology*
  • Plasmodium falciparum / isolation & purification
  • Plasmodium vivax / immunology*
  • Plasmodium vivax / isolation & purification
  • Protozoan Proteins / immunology
  • Schools
  • Seroepidemiologic Studies
  • Spatial Analysis


  • Antibodies, Protozoan
  • Antigens, Protozoan
  • Membrane Proteins
  • Merozoite Surface Protein 1
  • Protozoan Proteins
  • apical membrane antigen I, Plasmodium
  • glutamate-rich protein, Plasmodium