The burden of malaria in some areas of sub-Saharan Africa (SSA) has started to decline over recent years: analyses of hospital admission data provide evidence of declining morbidity and mortality in Kenya [
1,
2], The Gambia [
3], South Africa [
4], Zanzibar [
5], and Eritrea [
6]. Such reductions have been variously attributed to the expanded distribution of insecticide-treated nets (ITNs), changing first-line treatments to artemisinin combination therapy (ACT) and increasing access to it, and the renewed use of indoor residual spraying (IRS). There are, however, fewer reports on the impact of these interventions on malaria transmission [
5,
7]. This is partly due to the technical and ethical difficulties associated with quantifying transmission using vector-based indices, such as the entomological inoculation rate [
8]. A more frequently used malariometric index is the
Plasmodium falciparum parasite rate (
Pf PR): the proportion of surveyed persons harbouring parasites in their peripheral blood. The
Pf PR among children aged 2-10 years provides an indirect quantitative measure of transmission intensity across a range of malaria endemicities [
9,
10]. Historically, the measurement of
Pf PR had important roles during the first phase of the Global Malaria Elimination Programme (GMEP) and was subsequently used to monitor progress and verify interruption of transmission [
11]. Moreover, contemporary maps of
Pf PR can provide important information for national malaria control programmes by targeting interventions according to endemicity, thus cost-effectively targeting resources for malaria control [
12,
13].
Currently, the most robust sampling framework for national malaria surveys are household cluster surveys, including: Demographic and Health Surveys [
14], the Multiple Indicator Cluster Surveys [
15], and Malaria Indicator Surveys (MIS) [
16]. All of these surveys collect household-level information on malaria intervention coverage, patterns of anti-malarial use, and in selected MIS, on the prevalence of malaria infection and anaemia among pregnant women and children under five years of age. However, estimating
Pf PR among these age groups is not optimal as pregnant women sequester infections [
17] and infection prevalence in very young children is modified by a variety of factors including presence of maternal antibodies [
18,
19]. More importantly, national cluster surveys are expensive, time-consuming, technically complicated to undertake, and sampling is typically powered to provide only national or in some instances, first-level administrative unit (e.g. State or Province) representative estimates of malaria risk and intervention coverage. Such limitations preclude frequent monitoring and evaluation, beyond the first administrative level, hindering decentralized planning and allocation of resources for targeted control. Increasing the frequency of monitoring risk enables prompt feedback of intervention effectiveness, helping control programmes to adapt and improve control strategies. Across much of SSA, routine collection of malaria information at district levels currently focuses on passive case detection data on suspected malaria cases compiled by health facilities. However, these data are almost universally incomplete [
20], lack diagnostic precision [
21], and are rarely used for planning purposes. Because of these shortcomings, alternative sampling methods for monitoring malaria risk and intervention coverage are being explored, including household lot quality assurance sampling [
22,
23] and expanded programme of immunization (EPI) contact sampling [
24,
25]. This article reviews the historical experience and current rationale for the use of schools and school children as a complementary, inexpensive framework for malaria planning, monitoring and evaluation.