TITLE: Scoping Review: Malaria risk stratification and incidence mapping
AUTHORS: Jessica Craig, Donal Bisanzio, Richard Reithinger

[DESCRIPTION]
Context: As countries continue to make progress against
malaria at national level, transmission of malaria and, hence, risk becomes increasingly
heterogeneous. To maximize available resources and ensure that effective
interventions continue to have their desired epidemiological impact, Ministries
of Health and National Malaria Control Programs need to be able to stratify their
malaria burden so that specific interventions are tailored and targeted to
well-defined strata—based on a multitude of factors, including
socio-demographics, climatic variables, operational context, and/or epidemiology.
Currently, there is no unified or standardized approach how countries should
stratify their malaria burden and allocate their programmatic resources,
including to target programmatic interventions. The objective of this scoping
review is to map and summarize the different analytical approaches that have
been used for malaria stratification. 

Methods: 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.

[STEPS]
SECTION: Rationale
1. 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 allocation
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. 
SECTION: Objectives
2. 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].
SECTION: Information Sources
3. 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.
SECTION: Search Strategy
4. 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. 
SECTION: Study Records
5. 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.
SECTION: Eligibility Criteria
6. No exclusion criteria were applied in terms of time period or language.
SECTION: Data Items
7. 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.
SECTION: Data Synthesis
8. 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.