Abstract
Local and cross-border importation remain major challenges to malaria elimination and are difficult to measure using traditional surveillance data. To address this challenge, we systematically collected parasite genetic data and travel history from thousands of malaria cases across northeastern Namibia and estimated human mobility from mobile phone data. We observed strong fine-scale spatial structure in local parasite populations, providing positive evidence that the majority of cases were due to local transmission. This result was largely consistent with estimates from mobile phone and travel history data. However, genetic data identified more detailed and extensive evidence of parasite connectivity over hundreds of kilometers than the other data, within Namibia and across the Angolan and Zambian borders. Our results provide a framework for incorporating genetic data into malaria surveillance and provide evidence that both strengthening of local interventions and regional coordination are likely necessary to eliminate malaria in this region of Southern Africa.
Highlights
Renewed efforts against malaria have resulted in substantial gains in malaria control, with active plans to eliminate malaria from 35 countries (Newby et al, 2016)
We demonstrated that augmentation of traditional malaria surveillance with parasite genetic data added substantially to the understanding of transmission epidemiology in a critical region of Southern Africa straddling the border between Namibia, Angola, and Zambia
Parasite genetics provided positive evidence that the majority of malaria cases observed in northeastern Namibia were due to local transmission, evidenced by the strong fine-scale spatial structure in the genetic data
Summary
Renewed efforts against malaria have resulted in substantial gains in malaria control, with active plans to eliminate malaria from 35 countries (Newby et al, 2016). Malaria elimination requires that national and regional strategies consider the impact of local and cross-border importation on local. Epidemiology and Global Health eLife digest : The number of malaria cases has dropped in some Southern Africa countries, but others still remain seriously affected. When people travel within and between countries, they can bring the parasites that cause the disease to different areas. This can fuel local transmission or even lead to outbreaks in a malaria-free area
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