Geo-epidemiological risk stratification to select malaria interventions, case of Mali

Malaria is a public health threat in Mali, with high morbidity (37%) and mortality (25%) rates. Malaria risk stratification is needed to identify different risk transmission and select interventions, especially in resource-limited contexts. For the new National Strategic Plan, we updated stratification with World Health Organization (WHO) recommendation and presents the selection of interventions based on stratification. Data collection covered all the 75 Health Districts (HDs) in the country for the period 2018-2022. This was further supplemented by national survey data on parasitology and entomology in Mali. To estimate the adjusted incidence, the analysis considered health data reporting, malaria diagnostic positivity and health facility attendance rates at health district level to malaria cases estimated. Mixed interventions were defined based on adjusted incidence, prevalence, seasonality, vector resistance to insecticides and parasite distribution by Health Districts or region according to data available. Four strata have been defined according to the 2017 WHO Malaria Elimination Framework. Most HDs (54) fall within the highest and moderate transmission areas, covering 84% of the population (about 18 million) located in the southern and central regions. A total of 10 intervention packages were selected. We identified 61 out of 75 eligible HDs for the LLINs mass distribution campaign, 57 HDs for SMC, 67 for IPTp including community IPTp and 19 HD for vaccination. Geo-epidemiology of malaria risk and selection of interventions identified 55 districts with high malaria burden where major interventions will continue, specifically SMC, distribution of ITNs, and gradual introduction of vaccination in some of these 19 districts. Malaria stratification was critical for strategic planning and appropriate deployment of malaria control interventions in Mali.