Assessing malaria risk at night-time venues in a low-transmission setting: a time-location sampling study in Zambezi, Namibia

Identifying efficient and effective strategies to reach and monitor populations at greatest risk of malaria in low-transmission settings is a key challenge for malaria elimination. In Namibia’s Zambezi Region, transmission is ongoing yet its drivers remain poorly understood. A growing literature suggests that night-time social activities may lead to malaria exposure that is beyond the reach of conventional preventive interventions, such as insecticide treated bed nets and indoor residual spraying.

Formative research was conducted with community members in March, 2015 in the catchment areas of six randomly selected health facilities in the western Zambezi Region to identify night-time locations where large numbers of individuals regularly congregate. Using time-location sampling, a survey was conducted between March and May, 2015 at community-identified venues (bars and evening church services) to develop representative estimates of the prevalence of parasite infection and risk factors among venue-goers.

When compared to a contemporaneous household survey of the general population aged 15 and older (N = 1160), venue-goers (N = 480) were more likely to have spent the night away from their home recently (17.3% vs. 8.9%, P = 0.008), report recent fever (65.2% vs. 36.9%, P < 0.001), and were less likely to have sought care for fever (37.9% vs. 52.1%, P = 0.011). Venue-goers had higher, but not significantly different, rates of malaria infection (4.7% vs. 2.8%, P = 0.740). Risk factors for malaria infection among venue-goers could not be determined due to the small number of infections identified, however self-reported fever was positively associated with outdoor livelihood activities (adjusted odds ratio [AOR] = 1.9, 95% CI 1.0–3.3), not wearing protective measures at the time of the survey (AOR = 6.8, 9% CI 1.4–33.6) and having been bothered by mosquitos at the venue (AOR = 2.7, 95% CI 1.5–4).

Prevention measures and continued surveillance at night-time venues may be a useful complement to existing malaria elimination efforts.