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The use of spatial and genetic tools to assess Plasmodium falciparum transmission in Lusaka, Zambia between 2011 and 2015

Authors
  • Bridges, Daniel J.1, 2
  • Chishimba, Sandra1, 2
  • Mwenda, Mulenga1, 2
  • Winters, Anna M.2, 3
  • Slawsky, Erik4
  • Mambwe, Brenda1
  • Mulube, Conceptor1
  • Searle, Kelly M.5
  • Hakalima, Aves6
  • Mwenechanya, Roy2, 7
  • Larsen, David A.2, 4
  • 1 PATH MACEPA, National Malaria Elimination Centre, Gt East Rd, Lusaka, Zambia , Lusaka (Zambia)
  • 2 Akros, 45A Roan Road, Lusaka, Zambia , Lusaka (Zambia)
  • 3 University of Montana, Missoula, MT, USA , Missoula (United States)
  • 4 Syracuse University, Syracuse, NY, USA , Syracuse (United States)
  • 5 University of Minnesota, Minneapolis, MN, USA , Minneapolis (United States)
  • 6 Ministry of Health, Lusaka, Zambia , Lusaka (Zambia)
  • 7 University of Zambia, Lusaka, Zambia , Lusaka (Zambia)
Type
Published Article
Journal
Malaria Journal
Publisher
Springer (Biomed Central Ltd.)
Publication Date
Jan 15, 2020
Volume
19
Issue
1
Identifiers
DOI: 10.1186/s12936-020-3101-7
Source
Springer Nature
Keywords
License
Green

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.

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