Presented by Kelly Searle, ScM, PhD
Assistant Professor, Division of Epidemiology & Community Health
University of Minnesota
Over the past 2 decades there has been a renewed interest in global malaria eradication. This has led to dramatically increased malaria control and elimination efforts in many countries across the African region where 90% of malaria infections occur. As a result, many countries have experienced subsequent declines in clinical malaria cases, and Plasmodium falciparum malaria infections. Zambia has experienced these declines and currently envisions malaria elimination as a reasonable target. The Zambian National Malaria Elimination Programme (NMEP) has developed a sub-national approach beginning with Southern Province where malaria transmission is the lowest. This involves the expansion of community-based care and enhanced surveillance. In light of these efforts, malaria transmission has continued at low levels with seasonal cases of clinical malaria each year. Reactive case detection is currently conducted in Southern Province, Zambia to enhance surveillance and clear the asymptomatic reservoir. After an index case is confirmed with malaria at a healthcare facility by rapid diagnostic test (RDT), household members and neighbors within 140-meters of the index case are tested with an RDT and treated with artemether-lumefantrine (ACT). This surveillance system was used as a sampling method to enroll households in a longitudinal cohort in the Macha region in Southern Province, Zambia to understand the ongoing transmission dynamics. I will present recent results from 2 years of follow-up (2016-2018). My analysis integrate data on individual characteristics, parasite genomics, household characteristics, environmental characteristic, and indoor and outdoor vector counts to determine factors associated with infection, local transmission, and importation. I will frame these findings in the context of my previous work to understand the complex natural history of malaria transmission as it transitioned from hyper-endemic to approaching elimination.