Abstract
BackgroundZambia has set itself the ambitious target of eliminating malaria by 2021. To continue tracking transmission to zero, new interventions, tools and approaches are required.MethodsUrban reactive case detection (RCD) was performed in Lusaka city from 2011 to 2015 to better understand the location and drivers of malaria transmission. Briefly, index cases were followed to their home and all consenting individuals living in the index house and nine proximal houses were tested with a malaria rapid diagnostic test and treated if positive. A brief survey was performed and for certain responses, a dried blood spot sample collected for genetic analysis. Aggregate health facility data, individual RCD response data and genetic results were analysed spatially and against environmental correlates.ResultsTotal number of malaria cases remained relatively constant, while the average age of incident cases and the proportion of incident cases reporting recent travel both increased. The estimated R0 in Lusaka was < 1 throughout the study period. RCD responses performed within 250 m of uninhabited/vacant land were associated with a higher probability of identifying additional infections.ConclusionsEvidence suggests that the majority of malaria infections are imported from outside Lusaka. However there remains some level of local transmission occurring on the periphery of urban settlements, namely in the wet season. Unfortunately, due to the higher-than-expected complexity of infections and the small number of samples tested, genetic analysis was unable to identify any meaningful trends in the data.
Highlights
Zambia has set itself the ambitious target of eliminating malaria by 2021
Trends in incident malaria cases 2011–2015 Between 2011 and 2015, 14,966 confirmed incident malaria cases were reported for all health facilities within Lusaka district, of which 8723 confirmed cases were reported from health facilities which were participating in this study at the time (10 health facility (HF) in 2011–2014, 27 HFs in 2014–2015)
Genetic analysis From 2014, a further aim of collecting a dried blood spots (DBS) from every index case and all reactive case detection (RCD) participants was added to the protocol
Summary
Zambia has set itself the ambitious target of eliminating malaria by 2021. Scale-up of insecticide-treated mosquito nets (ITN) to prevent malaria transmission and effective artemisinin-based combination therapy (ACT) to treat malaria among those infected have greatly reduced the burden of malaria in sub-Saharan Africa [1]. Inspired by the progress that these interventions have made, attention is turning away from just controlling malaria disease and reducing deaths to eliminating transmission of the parasite. Zambia is one country that has made great strides in reducing malaria through implementing proven interventions [2], and has set itself the ambitious. While rural settings contribute the majority of transmission events, urban malaria persists and unless understood presents a threat to elimination [4, 6]. Zambia’s urban population increased from 35% of the total in 2000 to 40% in 2010 [8]
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