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Observational Study
. 2024 May 21;111(1):35-42.
doi: 10.4269/ajtmh.23-0466. Print 2024 Jul 3.

Malaria Transmission at The Zimbabwe-Mozambique Border: An Observational Study of Parasitemia by Travel History and Household Location

Ellen Ferriss  1 , Sungano Mharakurwa  2 , Shungu Munyati  3 , Lovemore Gwanzura  3   4 , Marisa A Hast  5 , Lawrence H Moulton  1   6 , Amy Wesolowski  5 , William J Moss  1   5   7
Affiliations
Observational Study

Malaria Transmission at The Zimbabwe-Mozambique Border: An Observational Study of Parasitemia by Travel History and Household Location

Ellen Ferriss et al. Am J Trop Med Hyg. .

Abstract

Cross-border human population movement contributes to malaria transmission in border regions, impeding national elimination. However, its impact in low-to-moderate transmission settings is not well characterized. This community-based study in Mutasa District, Zimbabwe, estimated the association of parasite prevalence with self-reported overnight travel to Mozambique and household distance to the border from 2012-2020. A fully adjusted Poisson regression model with robust variance estimation was fit using active surveillance data. The population attributable fraction of parasite prevalence from overnight travel was also estimated. The relative risk of testing positive for malaria by rapid diagnostic test declined 14% (prevalence ratio [PR] = 0.86, 95% CI = 0.81-0.92) per kilometer from the border up to 12 km away. Travel to Mozambique was associated with a 157% increased risk (PR = 2.57, 95% CI = 1.38-4.78), although only 5.8% of cases were attributable to overnight travel (95% CI = -1.1% to 12.7%), reflecting infrequent overnight trips (1.3% of visits). This study suggests that transmission in eastern Zimbabwe is driven by increasingly conducive social or environmental conditions approaching the border and low levels of importation from overnight travel. Although day trips to Mozambique during peak biting hours were not assessed, the contribution of such trips to ongoing transmission may be significant. Future malaria control efforts should prioritize high coverage of existing interventions and continued support for community health workers and health facilities at the border, which provide free case management.

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Figures

Figure 1.
Figure 1.
The proportion of household visits during which at least one household member was positive for malaria by rapid diagnostic test from 2012 through 2020 at the International Centers of Excellence for Malaria Research (ICEMR) study site in Mutasa District, Zimbabwe. RDT = rapid diagnostic test.
Figure 2.
Figure 2.
Monthly parasite prevalence by rapid diagnostic test from 2012 through 2020. Indoor residual spraying (IRS) insecticide transitions are shown by vertical lines. Participant test results are jittered, with positive tests above and negative tests below. RDT = rapid diagnostic test.
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References

    1. World Health Organization , 2022. World Malaria Report 2022. Geneva, Switzerland: WHO.
    1. World Health Organization , 2017. Malaria Country Profiles: Zimbabwe. Available at: https://www.who.int/publications/m/item/malaria-2017-country-profile-zwe. Accessed January 1, 2021.
    1. U.S. President’s Malaria Initiative , 2018. Zimbabwe: Malaria Operational Plan FY 2018. Available at: https://uat.pmi.gov/wp-content/uploads/2021/03/fy-2018-zimbabwe-malaria-.... Accessed January 1, 2021.
    1. Zimbabwe Ministry of Health and Child Care , 2016. A Situational Assessment of Malaria Risk, Prevention and Control in Communities along the Zimbabwe-Mozambique Border, 2015.
    1. Southern Africa Development Community Elimination Eight Secretariat Malaria Border Health Post Evaluation Study. Windhoek, Namibia: Elimination 8.

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