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Open Access 01-12-2018 | Research article

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

Authors: Gillian H. Stresman, Julia Mwesigwa, Jane Achan, Emanuele Giorgi, Archibald Worwui, Musa Jawara, Gian Luca Di Tanna, Teun Bousema, Jean-Pierre Van Geertruyden, Chris Drakeley, Umberto D’Alessandro

Published in: BMC Medicine | Issue 1/2018

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.

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Title: Do hotspots fuel malaria transmission: a village-scale spatio-temporal analysis of a 2-year cohort study in The Gambia
Authors: Gillian H. Stresman
Julia Mwesigwa
Jane Achan
Emanuele Giorgi
Archibald Worwui
Musa Jawara
Gian Luca Di Tanna
Teun Bousema
Jean-Pierre Van Geertruyden
Chris Drakeley
Umberto D’Alessandro
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: BMC Medicine / Issue 1/2018
Electronic ISSN: 1741-7015
DOI: https://doi.org/10.1186/s12916-018-1141-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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