Genomic malaria surveillance of antenatal care users detects reduced transmission following elimination interventions in Mozambique

 Effective surveillance is crucial for guiding malaria control and elimination efforts. As malaria transmission declines, sensitive tools are needed to detect changes in parasite populations and inform intervention strategies. Brokhattingen et al. present a promising approach for cost-effective genomic surveillance of Plasmodium falciparum by demonstrating that pregnant women attending their first antenatal care (ANC) visit can serve as a sentinel population, providing a representative snapshot of the circulating parasite population.

Using amplicon sequencing, the authors show that key parasite population parameters, including genetic diversity and drug resistance marker prevalence, are consistent between ANC attendees and children in the community across different transmission settings in southern Mozambique. Importantly, in an area targeted for malaria elimination, they detected declining parasite diversity and increased relatedness in both populations, indicating a reduction in transmission that was not apparent from epidemiological data alone.

This study highlights the value of genomic surveillance as a complementary tool to monitor the impact of malaria control and elimination interventions. By leveraging existing ANC platforms, this approach offers a practical and efficient means to track parasite population dynamics over time, particularly in low transmission settings where traditional surveillance methods may lack sensitivity.