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Abstract
BackgroundSpatio-temporal variations in malaria burden are currently complex and costly to measure, but are important for decision-making. We measured the spatio-temporal variation of clinical malaria incidence at a fine scale in a cohort of children under five in an endemic area in rural Chikhwawa, Malawi, determined associated factors, and monitored adult mosquito abundance.MethodsWe followed-up 285 children aged 6–48 months with recorded geolocations, who were sampled in a rolling malaria indicator survey, for one year (2015–2016). Guardians were requested to take the children to a nearby health facility whenever ill, where health facility personnel were trained to record malaria test results and temperature on the child’s sick-visit card; artemisinin-based combination therapy was provided if indicated. The cards were collected and replaced 2-monthly. Adult mosquitoes were collected from 2-monthly household surveys using a Suna trap. The head/thorax of adult Anopheles females were tested for presence of Plasmodium DNA. Binomial logistic regression and geospatial modelling were performed to determine predictors of and to spatially predict clinical malaria incidence, respectively.ResultsTwo hundred eighty two children, with complete results, and 267.8 child-years follow-up time were included in the analysis. The incidence rate of clinical malaria was 1.2 cases per child-year at risk; 57.1% of the children had at least one clinical malaria case during follow-up. Geographical groups of households where children experienced repeated malaria infections overlapped with high mosquito densities and high entomological inoculation rate locations.ConclusionsRepeated malaria infections within household groups account for the majority of cases and signify uneven distribution of malaria risk within a small geographical area.
Highlights
Spatio-temporal variations in malaria burden are currently complex and costly to measure, but are important for decision-making
Spatio-temporal variations in malaria burden are due to individual, household, community and environmental factors [1,2,3,4,5]
We describe the spatio-temporal variation in adult mosquito abundance
Summary
Spatio-temporal variations in malaria burden are currently complex and costly to measure, but are important for decision-making. We measured the spatio-temporal variation of clinical malaria incidence at a fine scale in a cohort of children under five in an endemic area in rural Chikhwawa, Malawi, determined associated factors, and monitored adult mosquito abundance. There is a need to monitor and identify spatio-temporal variations of malaria burden to inform decision-making; measuring these variations is complex and costly. Measuring clinical malaria in children, by using age as a proxy to previous exposure, may be useful in monitoring the spatial and temporal patterns of burden in the community. These patterns enable identification of high malaria burden areas to inform decisionmaking. Prospective cohort studies of clinical malaria incidence in children, reporting high spatial resolution, are unavailable from Malawi and are limited from most high-transmission settings
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