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BMC Med. 2018 Sep 14;16(1):160. doi: 10.1186/s12916-018-1141-4.

Do hotspots fuel malaria transmission: a village-scale spatio-temporal analysis of a 2-year cohort study in The Gambia.

Author information

1
Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, UK. Gillian.Stresman@lshtm.ac.uk.
2
Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia.
3
University of Antwerp, Antwerp, Belgium.
4
CHICAS, Lancaster Medical School, Lancaster University, Lancaster, UK.
5
Queen Mary University of London, London, UK.
6
Department of Medical Microbology, Radboud Medical University, Nijmegen, The Netherlands.
7
Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, UK.

Abstract

BACKGROUND:

Despite the biological plausibility of hotspots fueling malaria transmission, the evidence to support this concept has been mixed. If transmission spreads from high burden to low burden households in a consistent manner, then this could have important implications for control and elimination program development.

METHODS:

Data from a longitudinal cohort in The Gambia was analyzed. All consenting individuals residing in 12 villages across the country were sampled monthly from June (dry season) to December 2013 (wet season), in April 2014 (mid dry season), and monthly from June to December 2014. A study nurse stationed within each village recorded passively detected malaria episodes between visits. Plasmodium falciparum infections were determined by polymerase chain reaction and analyzed using a geostatistical model.

RESULTS:

Household-level observed monthly incidence ranged from 0 to 0.50 infection per person (interquartile range = 0.02-0.10) across the sampling months, and high burden households exist across all study villages. There was limited evidence of a spatio-temporal pattern at the monthly timescale irrespective of transmission intensity. Within-household transmission was the most plausible hypothesis examined to explain the observed heterogeneity in infections.

CONCLUSIONS:

Within-village malaria transmission patterns are concentrated in a small proportion of high burden households, but patterns are stochastic regardless of endemicity. Our findings support the notion of transmission occurring at the household and village scales but not the use of a targeted approach to interrupt spreading of infections from high to low burden areas within villages in this setting.

KEYWORDS:

Cohort; Foci; Geostatistics; Hotspot; Spatial epidemiology

PMID:
30213275
PMCID:
PMC6137946
DOI:
10.1186/s12916-018-1141-4
[Indexed for MEDLINE]
Free PMC Article

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