Abstract
.The island of Hispaniola aims to eliminate malaria by 2025; however, there are limited data to describe epidemiologic risk factors for malaria in this setting. A prospective case–control study was conducted at four health facilities in southwest Haiti, aiming to describe factors influencing the risk of current and past malaria infection. Cases were defined as individuals attending facilities with current or recent fever and positive malaria rapid diagnostic test (RDT), while controls were those with current or recent fever and RDT negative. Serological markers of recent and cumulative exposure to Plasmodium were assessed using the multiplex bead assay from dried blood spots and used for alternate case definitions. Kuldorff’s spatial scan statistic was used to identify local clusters of infection or exposure. Logistic regression models were used to assess potential risk factors for RDT positivity and recent exposure markers, including age-group, gender, and recruiting health facility as group-matching variables. A total of 192 cases (RDT positive) and 915 controls (RDT negative) were recruited. Consistent spatial clusters were identified for all three infection and exposure metrics, indicating temporal stability of malaria transmission at these sites. Risk factors included remoteness from health facilities and household construction, furthermore, insecticide-treated net ownership or use was associated with reduced odds of RDT positivity. These findings indicate the malaria risk in Grand’Anse is driven primarily by location. Travel, occupation, and other behavioral factors were not associated with malaria. These data can support the National Malaria Program to refine and target their intervention approaches, and to move toward elimination.
Highlights
The island of Hispaniola is the only location in the Caribbean with ongoing malaria transmission, and most malaria cases in Hispaniola occur in Haiti.[1]
During the follow-up interview, errors in data collection led to information on insecticidetreated net (ITN) use not being recorded for 146 individuals (32 rapid diagnostic test (RDT) positive and 114 RDT negative)
Missing ITN use data were more common among underfives (33% of missing versus 21% of non-missing), maleheaded households, and individuals recruited at Mandou facility (56% of missing)
Summary
The island of Hispaniola is the only location in the Caribbean with ongoing malaria transmission, and most malaria cases in Hispaniola occur in Haiti.[1]. Haiti is using a multipronged approach including improved surveillance systems, vector control, expansion of malaria case management to the community level, and piloting geographically targeted interventions such as mass drug administration. Limited data are available from Haiti to describe population groups or characteristics which are associated with the increased risk of malaria. To help Haiti achieve malaria elimination, data describing demographic, behavioral, or geographic risk factors are needed by the National Malaria Control Program (Programme National de Controle de la Malaria [PNCM]) to assist with refining and targeting intervention and elimination approaches. Formative research suggests that populations in malaria-risk areas of Haiti associate malaria with “dirty environments” (swamps, trash and dirty yards, and proximity to livestock) but believe that there are no clearly defined high-risk populations because “mosquitoes are everywhere” and are perceived to bite people indiscriminately.[2] Anopheles albimanus is the principal malaria vector in Haiti, and they are generally
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