Spatial patterns of malaria infection among children under 5 in Guinea

Background Malaria remains one of the major public health threats in sub-Saharan Africa. Guinea, where the disease burden remains very high, exhibits a highly heterogeneous transmission pattern. This study aims to assess the agreement between two malaria diagnostic tests and analyse spatial patterns in disease distribution. The approach also highlights local variations to support and improve public health decision-making.

This study uses data from the 2021 Guinea Malaria Indicator Survey. It applies Cohen's Kappa test to assess the agreement between rapid diagnostic and microscopic tests. Spatial analyses are then conducted, including autocorrelation, hotspot detection, and local bivariate analysis, to explore spatial relationships between variables across different locations.

The Kappa statistic shows moderate agreement between microscopic and rapid diagnostic test results. Global Moran's I indicates a marked spatial clustering of infections. The Anselin Local Moran's I scatter plot reveals that some neighbouring localities exhibit similar malaria prevalence, while others show notable contrasts. The Getis-Ord Gi* hotspot analysis identifies a high concentration of infections in northern and southern Nzérékoré, south-western Kankan, southern Faranah, and central Kindia. Bivariate geospatial analysis highlights different types of relationships between covariates and malaria prevalence levels.

Priority intervention areas include northern and southern Nzerekore, south-western Kankan, southern Faranah, and southern and central Kindia. The study recommends strengthening community surveillance using rapid diagnostic tests and improving the distribution of long-lasting insecticidal nets, while taking into account user preferences and seasonal timing. It also highlights the need to increase domestic funding to ensure sustainable malaria control.