Micro-contexts of malaria risk in pre-elimination settings

As malaria transmission reduces, spatial heterogeneity in transmission becomes more marked, such that there can be considerable difference in malaria risk even between households in the same village. Transmission may persist in ‘hotspots’ despite application of standard control measures and even when malaria incidence in the surrounding region declines. As malaria control efforts progress towards elimination, it will be increasingly important to understand the factors that influence the persistence of malaria transmission at small spatial scales. ‘Micro-epidemiological’ studies of fine-scale heterogeneity in transmission are usually restricted to investigating quantifiable, previously identified risk factors and rarely assess the confluence of factors that drive transmission at these small scales. Anthropology studies may yield complementary data on factors such as territorial arrangements, household construction, mobility patterns, land use patterns and health seeking behaviours that may partly explain persistent transmission. Through case studies in low-transmission settings in Vietnam and Peru, this study aims to integrate spatial and malariometric epidemiological data with anthropological data and molecular biology data on genetic parasite population structures to understand the ‘micro-context’ of malaria risk.

Trefwoorden:B680-volksgezondheid