Malaria Surveillance Using PCR Pooling in the Pre-Elimination Era: A Scoping Review
Abstract
WHO aims to eliminate malaria by 2030. Most of the cases and deaths were in the African Region, followed by the South-East Asia Region. With the number of cases decrease annually, more sensitive methods are needed for pre-elimination malaria surveillance program in endemic areas. Polymerase Chain Reaction (PCR) offers higher sensitivity and specificity, and with the integration of pooling strategies have further reduced costs. This review evaluates the application of PCR on sample pooling to enhance malaria surveillance in low-prevalence settings. A systematic search across two electronic databases identified 16 eligible studies, encompassing regions in Africa, Southeast Asia, and South America. Sample sources included whole blood (WB), Packed Red Cell (PRC), Dried Blood Spots (DBS), and serum. Pooling sizes ranged from 3 to 50 samples per pool, with hierarchical and matrix-based approaches utilized. The studies showed that PCR pooling maintained high sensitivity and specificity, detecting infections missed by microscopy or Rapid Diagnostic Test (RDT). In regions with malaria prevalence below 10%, pooling reduced testing costs by up to 50%. These findings support PCR on sample pooling as a reliable and scalable tool for pre-elimination surveillance programs. Future research should focus on optimizing sample types, pooling sizes, and standardized protocols to ensure both consistency and efficiency in malaria detection.
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