Measuring changes in plasmodium falciparum transmission. Precision, accuracy and costs of metrics

Lucy S. Tusting, Teun Bousema, David L. Smith, Chris Drakeley

Research output: Chapter in Book/Report/Conference proceedingChapter

94 Scopus citations


As malaria declines in parts of Africa and elsewhere, and as more countries move towards elimination, it is necessary to robustly evaluate the effect of interventions and control programmes on malaria transmission. To help guide the appropriate design of trials to evaluate transmission-reducing interventions, we review 11 metrics of malaria transmission, discussing their accuracy, precision, collection methods and costs and presenting an overall critique. We also review the nonlinear scaling relationships between five metrics of malaria transmission: the entomological inoculation rate, force of infection, sporozoite rate, parasite rate and the basic reproductive number, R0. Our chapter highlights that while the entomological inoculation rate is widely considered the gold standard metric of malaria transmission and may be necessary for measuring changes in transmission in highly endemic areas, it has limited precision and accuracy and more standardised methods for its collection are required. In areas of low transmission, parasite rate, seroconversion rates and molecular metrics including MOI and mFOI may be most appropriate. When assessing a specific intervention, the most relevant effects will be detected by examining the metrics most directly affected by that intervention. Future work should aim to better quantify the precision and accuracy of malaria metrics and to improve methods for their collection.

Original languageEnglish (US)
Title of host publicationAdvances in Parasitology
PublisherAcademic Press
Number of pages58
StatePublished - 2014

Publication series

NameAdvances in Parasitology
ISSN (Print)0065-308X


  • Elimination
  • Endemicity
  • Malaria
  • Metric
  • Plasmodium
  • Transmission
  • Vector

ASJC Scopus subject areas

  • Parasitology


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