Abstract
BackgroundThe burden of malaria has decreased dramatically within the past several years in parts of sub-Saharan Africa. Further malaria control will require targeted control strategies based on evidence of risk. The objective of this study was to identify environmental risk factors for malaria transmission using remote sensing technologies to guide malaria control interventions in a region of declining burden of malaria.MethodsSatellite images were used to construct a sampling frame for the random selection of households enrolled in prospective longitudinal and cross-sectional surveys of malaria parasitaemia in Southern Province, Zambia. A digital elevation model (DEM) was derived from the Shuttle Radar Topography Mission version 3 DEM and used for landscape characterization, including landforms, elevation, aspect, slope, topographic wetness, topographic position index and hydrological models of stream networks.ResultsA total of 768 individuals from 128 randomly selected households were enrolled over 21 months, from the end of the rainy season in April 2007 through December 2008. Of the 768 individuals tested, 117 (15.2%) were positive by malaria rapid diagnostic test (RDT). Individuals residing within 3.75 km of a third order stream were at increased risk of malaria. Households at elevations above the baseline elevation for the region were at decreasing risk of having RDT-positive residents. Households where new infections occurred were overlaid on a risk map of RDT positive households and incident infections were more likely to be located in high-risk areas derived from prevalence data. Based on the spatial risk map, targeting households in the top 80th percentile of malaria risk would require malaria control interventions directed to only 24% of the households.ConclusionsRemote sensing technologies can be used to target malaria control interventions in a region of declining malaria transmission in southern Zambia, enabling a more efficient use of resources for malaria elimination.
Highlights
IntroductionDeclines in the burden of malaria have been observed in Zambia, coincident with the widespread implementation of malaria control strategies, including the use of artemisinincombination therapy (ACT) as the first-line treatment regimen, the distribution of long-lasting insecticidal nets (LLINs), and targeted IRS [4]
The burden of malaria has decreased dramatically within the past several years in parts of subSaharan Africa
Declines in the burden of malaria have been observed in Zambia, coincident with the widespread implementation of malaria control strategies, including the use of artemisinincombination therapy (ACT) as the first-line treatment regimen, the distribution of long-lasting insecticidal nets (LLINs), and targeted IRS [4]
Summary
Declines in the burden of malaria have been observed in Zambia, coincident with the widespread implementation of malaria control strategies, including the use of ACT as the first-line treatment regimen, the distribution of long-lasting insecticidal nets (LLINs), and targeted IRS [4]. In Choma District, southern Zambia, paediatric hospitalizations at Macha Hospital for malaria decreased from approximately 1,400 admissions per malaria season in 2000-2001 to fewer than 50 per year in each of the past three years This decline began in 2004, shortly after the introduction of ACT, but before widespread distribution of LLINs. The decline in the burden of malaria in parts of subSaharan Africa has led to interest in malaria elimination and eradication [6]. Understanding the local epidemiology of malaria in southern African is critical to assessing the feasibility of regional malaria elimination
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