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Research output: Contribution to Journal/Magazine › Journal article › peer-review
Research output: Contribution to Journal/Magazine › Journal article › peer-review
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TY - JOUR
T1 - Do hotspots fuel malaria transmission
T2 - a village-scale spatio-temporal analysis of a2-year cohort study in The Gambia
AU - Stresman, Gillian H.
AU - Mwesigwa, Julia
AU - Achan, Jane
AU - Giorgi, Emanuele
AU - Worwui, Archibald
AU - Jawara, Musa
AU - Di Tanna, Gian Luca
AU - Bousema, Teun
AU - Van Geertruyden, Jean-Pierre
AU - Drakeley, Chris
AU - D'Alessandro, Umberto
PY - 2018/9/14
Y1 - 2018/9/14
N2 - BackgroundDespite 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.MethodsData 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.ResultsHousehold-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.ConclusionsWithin-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.
AB - BackgroundDespite 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.MethodsData 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.ResultsHousehold-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.ConclusionsWithin-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.
KW - Hotspot
KW - Foci
KW - Geostatistics
KW - Cohort
KW - Spatial epidemiology
U2 - 10.1186/s12916-018-1141-4
DO - 10.1186/s12916-018-1141-4
M3 - Journal article
VL - 16
JO - BMC Medicine
JF - BMC Medicine
SN - 1741-7015
M1 - 160
ER -