Volume 89, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Substantial development assistance has been directed towards reducing the high malaria burden in Malawi over the past decade. We assessed changes in transmission over this period of malaria control scale-up by compiling community rate (PR) data during 2000–2011 and used model-based geostatistical methods to predict mean PR in 2000, 2005, and 2010. In addition, we calculated population-adjusted prevalences and populations at risk by district to inform malaria control program priority setting. The national population-adjusted PR was 37% in 2010, and we found no evidence of change over this period of scale-up. The entire population of Malawi is under meso-endemic transmission risk, with those in districts along the shore of Lake Malawi and Shire River Valley under highest risk. The lack of change in prevalence confirms modeling predictions that when compared with lower transmission, prevalence reductions in high transmission settings require greater investment and longer time scales.

[open-access] This is an Open Access article distributed under the terms of the American Society of Tropical Medicine and Hygiene's Re-use License which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


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  1. Ministry of Health, Malawi, 2012. Malawi Health Management Information System (HMIS). Lilongwe, Malawi: Malawi Ministry of Health.
  2. Malawi Malaria Impact Evaluation Group, President's Malaria Initiative (PMI), 2012. Evaluation of the Impact of Malaria Interventions on Mortality in Children in Malawi. Washington, DC: U.S. Agency for International Development.
  3. National Statistical Office and ORC Macro, 2005. Malawi Demographic and Health Survey 2004. Calverton, MD: NSO and ORC Macro.
  4. National Statistical Office and ORC Macro, 2011. Malawi Demographic and Health Survey 2010. Calverton, MD: NSO and ORC Macro.
  5. Roca-Feltrer A, Kwizombe CJ, Sanjoaquin MA, Sesay SS, Faragher B, Harrison J, Geukers K, Kabuluzi S, Mathanga DP, Molyneux E, Chagomera M, Taylor T, Molyneux M, Heyderman RS, , 2012. Lack of decline in childhood malaria, Malawi, 2001–2010. Emerg Infect Dis 18: 272278.[Crossref]
  6. Ministry of Health, Malawi, 2011. National Malaria Indicator Survey 2010. Lilongwe, Malawi: Malawi Ministry of Health.
  7. Snow RW, Marsh K, le Sueur D, , 1996. The need for maps of transmission intensity to guide malaria control in Africa. Parasitol Today 12: 455457.[Crossref]
  8. Omumbo JA, Noor AM, Fall IS, Snow RW, , 2013. How well is malaria risk cartography used to design and finance malaria control in Africa? PLoS ONE 8: e53198.[Crossref]
  9. Kazembe LN, Kleinschmidt I, Holtz TH, Sharp BL, , 2006. Spatial analysis and mapping of malaria risk in Malawi using point-referenced prevalence infection data. Int J Health Geogr 5: 41.[Crossref]
  10. Spiers AA, Mzilahowa T, Atkinson D, McCall PJ, , 2002. The malaria vectors of the lower Shire Valley, Malawi. Malawi Med J 14: 47.
  11. Malawi Meteorological Services, 2012. Available at: http://www.metmalawi.com/. Accessed November 5, 2012.
  12. Mathanga DP, Walker ED, Wilson ML, Ali D, Taylor TE, Laufer MK, , 2012. Malaria control in Malawi: current status and directions for the future. Acta Trop 121: 212217.[Crossref]
  13. Mathanga DP, Campbell CH, Taylor TE, Barlow R, Wilson ML, , 2006. Socially marketed insecticide-treated nets effectively reduce Plasmodium infection and anaemia among children in urban Malawi. Trop Med Int Health 11: 13671374.[Crossref]
  14. Ministry of Health, Malawi, 2005. Malaria Strategic Plan 2005–2010. Lilongwe, Malawi: Malawi Ministry of Health.
  15. National Statistical Office (NSO), Malawi and ORC Macro, 2001. Malawi Demographic and Health Survey 2000. Calverton, MD: NSO and ORC Macro.
  16. National Statistical Office (NSO), Malawi and UNICEF, 2008. Malawi Multiple Indicator Cluster Survey 2006, Final Report. Lilongwe, Malawi: NSO and UNICEF.
  17. Ministry of Health, Malawi, UNICEF/CDC, 2001. Report of the National Micronutrient Survey. Available at: http://www.micronutrient.org/nutritiontoolkit/ModuleFolders/12.Data_entry_analysis_and_%20report_writing/Examples/Report_of_survey_in_Malawi.pdf. Accessed November 5, 2012.
  18. UNICEF/Irish Aid/CDC, 2009. Malawi National Micronutrient Survey. Available at: http://www.moafsmw.org/ocean/docs/Nutrition%20Docs/D%20FINAL%202009%20MALAWI%20MICRONUTRIENT%20REPORT%20cleared%20July%202011%2031%2010%2011.pdf. Accessed November 5, 2012.
  19. Mathanga DP, Campbell CH, Vanden Eng J, Wolkon A, Bronzan RN, Malenga GJ, Ali D, Desai M, , 2010. Comparison of anaemia and parasitaemia as indicators of malaria control in household and EPI-health facility surveys in Malawi. Malar J 9: 107.[Crossref]
  20. Skarbinski J, Mwandama D, Luka M, Jafali J, Wolkon A, Townes D, Campbell C, Zoya J, Ali D, Mathanga DP, , 2011. Impact of health facility-based insecticide treated bednet distribution in Malawi: progress and challenges towards achieving universal coverage. PLoS ONE 6: e21995.[Crossref]
  21. Smith DL, Guerra CA, Snow RW, Hay SI, , 2007. Standardizing estimates of the Plasmodium falciparum parasite rate. Malar J 6: 131.[Crossref]
  22. The AfriPop Project, 2011. Available at: s.ufl.edu/users/atatem/index_files/Details.htm. Accessed 15 January 2011.
  23. Gething PW, Van Boeckel TP, Smith DL, Guerra CA, Patil AP, Snow RW, Hay SI, , 2011. Modeling the global constraints of temperature on transmission of Plasmodium falciparum and P. vivax . Parasit Vectors 4: 92.[Crossref]
  24. Shuttle Radar Topography Mission (SRTM), 2000. Available at: http://www2.jpl.nasa.gov/srtm/. Accessed January 15, 2011.
  25. Hijmans RJ, Cameron SE, Parra JL, Jones PG, Jarvis A, , 2005. Very high resolution interpolated climate surfaces for global land areas. Int J Climatol 25: 19651978.[Crossref]
  26. WorldClim-Global Climate Database, 2012. Available at: www.wordlclim.org. Accessed February 10, 2012.
  27. MODIS- EVI data archives, 2011. Available at: ftp://n4ftl01u.ecs.nasa.gov/SAN/MOST/MOD10A2.005/. Accessed September 12, 2011.
  28. ESRI, 2011. Spatial Analyst Tool, ArcGIS Desktop, Release 10, 2011. Redlands, CA: Environmental Systems Research Institute.
  29. Miller A, , 2002. Subset Selection in Regression. Boca Raton, FL: Chapman and Hall.[Crossref]
  30. Lumley T, , 2010. Leaps: Regression Subset Selection (R Package) Version 2.7.
  31. Schwarz G, , 1978. Estimating dimensions of a model. Ann Stat 6: 461464.[Crossref]
  32. Malaria Atlas Project (MAP), 2011. P. falciparum Cartographic Code. Available at: https://github.com/malaria-atlas-project/mbgw-clean. Accessed October 2011.
  33. Patil A, Huard D, Fonnesbeck CJ, , 2010. PyMC: Bayesian stochastic modelling in Python. J Stat Softw 35: e1000301.[Crossref]
  34. Gething PW, Patil AP, Smith DL, Guerra CA, Elyazar IR, Johnston GL, Tatem AJ, Hay SI, , 2011. A new world malaria map: Plasmodium falciparum endemicity in 2010. Malar J 10.[Crossref]
  35. Banerjee S, Carlin BP, Gelfand AE, , 2004. Hierarchical Modeling and Analysis for Spatial Data. Monographs on Statistics and Applied Probability 101. Boca Raton, FL: Chapman and Hall/CRC Press LLC.
  36. Stein ML, , 2005. Space-time covariance functions. J Am Stat Assoc 100: 310321.[Crossref]
  37. Chizema-Kawesha E, Miller JM, Steketee RW, Mukonka VM, Mukuka C, Mohamed AD, Miti SK, Campbell CC, , 2010. Scaling up malaria control in Zambia: progress and impact 2005–2008. Am J Trop Med Hyg 83: 480488.[Crossref]
  38. Bhattarai A, Ali AS, Kachur SP, Mårtensson A, Abbas AK, Khatib R, Al-Mafazy AW, Ramsan M, Rotllant G, Gerstenmaier JF, Molteni F, Abdulla S, Montgomery SM, Kaneko A, Björkman A, , 2007. Impact of artemisinin-based combination therapy and insecticide-treated nets on malaria burden in Zanzibar. PLoS Med 4: e309.[Crossref]
  39. Barnes KI, Durrheim DN, Little F, Jackson A, Mehta U, Allen E, Dlamini SS, Tsoka J, Bredenkamp B, Mthembu DJ, White NJ, Sharp BL, , 2005. Effect of artemether-lumefantrine policy and improved vector control on malaria burden in KwaZulu-Natal, South Africa. PLoS Med 2: e330.[Crossref]
  40. Okiro EA, Bitira D, Mbabazi G, Mpimbaza A, Alegana VA, Talisuna AO, Snow RW, , 2011. Increasing malaria hospital admissions in Uganda between 1999 and 2009. BMC Med 9: 37.[Crossref]
  41. Okiro EA, Kazembe LN, Kabaria CW, Ligomeka J, Noor AM, Ali D, Snow RW, , 2013. Childhood malaria admission rates to four hospitals in Malawi between 2000 and 2010. PLoS ONE 8: e62214.[Crossref]
  42. Okiro EA, Alegana VA, Noor AM, Snow RW, , 2010. Changing malaria intervention coverage, transmission, and hospitalization in Kenya. Malar J 9: 285.[Crossref]
  43. Smith DL, Hay SI, Noor AM, Snow RW, , 2009. Predicting changing malaria risk after expanded insecticide-treated net coverage in Africa. Trends Parasitol 25: 511516.[Crossref]
  44. Griffin JT, Hollingsworth TD, Okell LC, Churcher TS, White M, Hinsley W, Bousema T, Drakeley CJ, Ferguson NM, Basáñez MG, Ghani AC, , 2010. Reducing Plasmodium falciparum malaria transmission in Africa: a model-based evaluation of intervention strategies. PLoS Med 7.[Crossref]
  45. Killeen GF, Smith TA, Ferguson HM, Mshinda H, Abdulla S, Lengeler C, Kachur SP, , 2007. Preventing childhood malaria by protecting adults from mosquitoes with insecticide-treated nets. PLoS Med 4.[Crossref]
  46. Hawley WA, Phillips-Howard PA, ter Kuile FO, Terlouw DJ, Vulule JM, Ombok M, Nahlen BL, Gimnig JE, Kariuki SK, Kolczak MS, Hightower AW, , 2003. Community-wide effects of permethrin-treated bednets on child mortality and malaria morbidity in western Kenya. Am J Trop Med Hyg 68 (Suppl 4): 121127.
  47. Howard S, Omumbo J, Some ES, Nevill C, Donnelly CA, Snow RW, , 2000. Evidence for a mass community effect of insecticide treated bed nets on the incidence of malaria on the Kenyan Coast. Trans R Soc Trop Med Hyg 94: 357360.[Crossref]
  48. Wondji CS, Coleman M, Kleinschmidt I, Mzilahowa T, Irving H, Ndula M, Rehman A, Morgan J, Barnes KG, Hemingway J, , 2012. Impact of pyrethroid resistance on operational malaria control in Malawi. Proc Natl Acad Sci USA 109.[Crossref]
  49. Trape JF, Tall A, Diagne N, Ndiath O, Ly AB, Faye J, Dieye-Ba F, Roucher C, Bouganali C, Badiane A, Sarr FD, Mazenot C, Touré-Baldé A, Raoult D, Druilhe P, Mercereau-Puijalon O, Rogier C, Sokhna C, , 2011. Malaria morbidity and pyrethroid resistance after the introduction of insecticide-treated bednets and artemisinin-based combination therapies: a longitudinal study. Lancet Infect Dis 11: 925932.[Crossref]
  50. Moiroux N, Gomez MB, Pennetier C, Elanga E, Djènontin A, Chandre F, Djègbé I, Guis H, Corbel V, , 2012. Changes in Anopheles funestus biting behavior following universal coverage of long-lasting insecticidal nets in Benin. J Infect Dis 206: 16221629.[Crossref]
  51. World Health Organization (WHO), 2011. World Malaria Report 2010. Available at: http://www.who.int/malaria/world_malaria_report_2010/en/index.html. Accessed November 5, 2011.
  52. Tatem AJ, Smith DL, , 2010. International population movements and regional Plasmodium falciparum malaria elimination strategies. Proc Natl Acad Sci USA 107: 1222212227.[Crossref]
  53. Ministry of Health, Malawi, 2011. Malaria Strategic Plan 2011–2015. Lilongwe, Malawi: Malai Ministry of Health.
  54. Victora CG, Black RE, Boerma JT, Bryce J, , 2011. Measuring impact in the Millennium Development Goal era and beyond: a new approach to large-scale effectiveness evaluations. Lancet 377: 8595.[Crossref]
  55. Noor AM, Alegana VA, Patil AP, Moloney G, Borle M, Yusuf F, Amran J, Snow RW, , 2012. Mapping the receptivity of malaria risk to plan the future of control in Somalia. BMJ Open 2: pii: e00160.[Crossref]
  56. Gething PW, Patil AP, Hay SI, , 2010. Quantifying aggregated uncertainty in Plasmodium falciparum malaria prevalence and populations at risk via efficient space-time geostatistical joint simulation. PloS Comput Bio 6: e1000724.[Crossref]

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Supplementary Data

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  • Received : 16 Jan 2013
  • Accepted : 02 Jul 2013

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