A micro-epidemiological analysis of febrile malaria in coastal Kenya showing hotspots within hotspots

Philip Bejon, Tom N. Williams, Christopher Nyundo, Simon I. Hay, David Benz, Peter W. Gething, Mark Otiende, Judy Peshu, Mahfudh Bashraheil, Bryan Greenhouse, Teun Bousema, Evasius Bauni, Kevin Marsh, David L. Smith, Steffen Borrmann

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Abstract

Malaria transmission is spatially heterogeneous. This reduces the efficacy of control strategies, but focusing control strategies on clusters or hotspots of transmission may be highly effective. Among 1,500 homesteads in coastal Kenya we calculated a) the fraction of febrile children with positive malaria smears per homestead, and b) the mean age of children with malaria per homestead. These two measures were inversely correlated, indicating that children in homesteads at higher transmission acquire immunity more rapidly. This inverse correlation increased gradually with increasing spatial scale of analysis, and hotspots of febrile malaria were identified at every scale. We found hotspots within hotspots, down to the level of an individual homestead. Febrile malaria hotspots were temporally unstable, but 4km radius hotspots could be targeted for one month following one month periods of surveillance.

Original languageEnglish (US)
Article numbere02130
JournaleLife
Volume2014
Issue number3
DOIs
StatePublished - Apr 24 2014

ASJC Scopus subject areas

  • Neuroscience(all)
  • Immunology and Microbiology(all)
  • Biochemistry, Genetics and Molecular Biology(all)

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    Bejon, P., Williams, T. N., Nyundo, C., Hay, S. I., Benz, D., Gething, P. W., Otiende, M., Peshu, J., Bashraheil, M., Greenhouse, B., Bousema, T., Bauni, E., Marsh, K., Smith, D. L., & Borrmann, S. (2014). A micro-epidemiological analysis of febrile malaria in coastal Kenya showing hotspots within hotspots. eLife, 2014(3), [e02130]. https://doi.org/10.7554/eLife.02130