Volume 95, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Malaria constitutes a major public health problem in Zimbabwe, particularly in the north and east bordering Zambia and Mozambique. In Manicaland Province in eastern Zimbabwe, malaria transmission is seasonal and unstable. Over the past decade, Manicaland Province has reported increased malaria transmission due to limited funding, drug resistance and insecticide resistance. The aim of this study was to identify risk factors at the individual and household levels to better understand the epidemiology of malaria and guide malaria control strategies in eastern Zimbabwe. Between October 2012 and September 2014, individual demographic data and household characteristics were collected from cross-sectional surveys of 1,116 individuals residing in 316 households in Mutasa District, one of the worst affected districts. Factors associated with malaria, measured by rapid diagnostic test (RDT), were identified through multilevel logistic regression models. A total of 74 participants were RDT positive. Sleeping under a bed net had a protective effect against malaria despite pyrethroid resistance in the mosquito vector. Multivariate analysis showed that malaria risk was higher among individuals younger than 25 years, residing in households located at a lower household density and in closer proximity to the Mozambique border. The risk factors identified need to be considered in targeting malaria control interventions to reduce host–vector interactions.


Article metrics loading...

Loading full text...

Full text loading...



  1. Hay SI, Okiro EA, Gething PW, Patil AP, Tatem AJ, Guerra CA, Snow RW, , 2010. Estimating the global clinical burden of Plasmodium falciparum malaria in 2007. PLoS Med 7: e1000290.[Crossref]
  2. Zimbabwe National Statistics Agency (ZNSA), 2012. Census 2012: Preliminary Report. Harare, Zimbabwe: National Statistics Agency.
  3. President's Malaria Initiative (PMI), 2015. Zimbabwe Malaria Operational Plan FY 2015. Washington, DC: President's Malaria Initiative.
  4. Craig MH, Snow RW, le Sueur D, , 1999. A climate-based distribution model of malaria transmission in sub-Saharan Africa. Parasitol Today 15: 105111.[Crossref]
  5. Ministry of Health and Child Welfare (MOHCW), 2012. Zimbabwe National Health Profile 2012. Harare, Zimbabwe: Ministry of Health and Child Welfare.
  6. Mharakurwa S, Thuma PE, Norris DE, Mulenga M, Chalwe V, Chipeta J, Munyati S, Mutambu S, Mason PR, , 2012. Malaria epidemiology and control in southern Africa. Acta Trop 121: 202206.[Crossref]
  7. Mharakurwa S, Mutambu SL, Mudyiradima R, Chimbadzwa T, Chandiwana SK, Day KP, , 2004. Association of house spraying with suppressed levels of drug resistance in Zimbabwe. Malar J 3: 35.[Crossref]
  8. Choi KS, Christian R, Nardini L, Wood OR, Agubuzo E, Muleba M, Munyati S, Makuwaza A, Koekemoer LL, Brooke BD, Hunt RH, Coetzee M, , 2014. Insecticide resistance and role in malaria transmission of Anopheles funestus populations from Zambia and Zimbabwe. Parasit Vectors 7: 464.[Crossref]
  9. Moss WJ, Norris DE, Mharakurwa S, Scott A, Mulenga M, Mason PR, Chipeta J, Thuma PE, , 2012. Challenges and prospects for malaria elimination in the southern Africa region. Acta Trop 121: 207211.[Crossref]
  10. Das S, Henning TC, Simubali L, Hamapumbu H, Nzira L, Mamini E, Makuwaza A, Muleba M, Norris DE, Stevenson JC, , 2015. Underestimation of foraging behaviour by standard field methods in malaria vector mosquitoes in southern Africa. Malar J 14: 12.[Crossref]
  11. Lowther SA, Curriero FC, Shields T, Ahmed S, Monze M, Moss WJ, , 2009. Feasibility of satellite image-based sampling for a health survey among urban townships of Lusaka, Zambia. Trop Med Int Health 14: 7078.[Crossref]
  12. Sutcliffe CG, Kobayashi T, Hamapumbu H, Shields T, Kamanga A, Mharakurwa S, Thuma PE, Glass G, Moss WJ, , 2011. Changing individual-level risk factors for malaria with declining transmission in southern Zambia: a cross-sectional study. Malar J 10: 324.[Crossref]
  13. Moss WJ, Hamapumbu H, Kobayashi T, Shields T, Kamanga A, Clennon J, Mharakurwa S, Thuma PE, Glass G, , 2011. Use of remote sensing to identify spatial risk factors for malaria in a region of declining transmission: a cross-sectional and longitudinal community survey. Malar J 10: 163.[Crossref]
  14. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG, , 2009. Research electronic data capture (REDCap): a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42: 377381.[Crossref]
  15. Vyas S, Kumaranayake L, , 2006. Constructing socio-economic status indices: how to use principal components analysis. Health Policy Plan 21: 459468.[Crossref]
  16. Rutstein SO, Johnson K, , 2004. The DHS Wealth Index. Calverton, MD: ORC Macro, MEASURE DHS.
  17. Shuttle Radar Topography Mission NASA (SRTM). SRTM Digital Elevation Model. Available at: http://www2.jpl.nasa.gov/srtm/. Accessed October 1, 2015.
  18. Atieli HE, Zhou G, Lee M-C, Kweka EJ, Afrane Y, Mwanzo I, Githeko AK, Yan G, , 2011. Topography as a modifier of breeding habitats and concurrent vulnerability to malaria risk in the western Kenya highlands. Parasit Vectors 4: 241.[Crossref]
  19. Black PE, , 2005. Watershed Hydrology. Water Encyclopedia 3: 472479
  20. U.S. Geological Survey (USGS) Land Processes Distributed Active Archive Center, (LP DAAC). MODIS Land Products. Available at: https://lpdaac.usgs.gov/dataset_discovery/modis/modis_products_table.
  21. Sutcliffe CG, Kobayashi T, Hamapumbu H, Shields T, Mharakurwa S, Thuma PE, Louis TA, Glass G, Moss WJ, , 2012. Reduced risk of malaria parasitemia following household screening and treatment: a cross-sectional and longitudinal cohort study. PLoS One 7: e31396.[Crossref]
  22. Ribeiro PJ, Jr Diggle PJ, , 2001. geoR: a package for geostatistical analysis. R News 1: 1418.
  23. Booman M, Durrheim DN, La Grange K, Martin C, Mabuza AM, Zitha A, Mbokazi FM, Fraser C, Sharp BL, , 2000. Using a geographical information system to plan a malaria control programme in South Africa. Bull World Health Organ 78: 14381444.
  24. Noor AM, Uusiku P, Kamwi RN, Katokele S, Ntomwa B, Alegana VA, Snow RW, , 2013. The receptive versus current risks of Plasmodium falciparum transmission in northern Namibia: implications for elimination. BMC Infect Dis 13: 184.[Crossref]
  25. Smith Gueye C, Gerigk M, Newby G, Lourenco C, Uusiku P, Liu J, , 2014. Namibia's path toward malaria elimination: a case study of malaria strategies and costs along the northern border. BMC Public Health 14: 1190.[Crossref]
  26. Wangdi K, Gatton ML, Kelly GC, Clements AC, , 2015. Cross-border malaria: a major obstacle for malaria elimination. Adv Parasitol 89: 79107.[Crossref]
  27. Pindolia DK, Garcia AJ, Wesolowski A, Smith DL, Buckee CO, Noor AM, Snow RW, Tatem AJ, , 2012. Human movement data for malaria control and elimination strategic planning. Malar J 11: 205.[Crossref]
  28. Cosner C, Beier JC, Cantrell RS, Impoinvil D, Kapitanski L, Potts MD, Troyo A, Ruan S, , 2009. The effects of human movement on the persistence of vector-borne diseases. J Theor Biol 258: 550560.[Crossref]
  29. Conteh L, Sharp BL, Streat E, Barreto A, Konar S, , 2004. The cost and cost-effectiveness of malaria vector control by residual insecticide house-spraying in southern Mozambique: a rural and urban analysis. Trop Med Int Health 9: 125132.[Crossref]
  30. Cohen JM, Smith DL, Cotter C, Ward A, Yamey G, Sabot OJ, Moonen B, , 2012. Malaria resurgence: a systematic review and assessment of its causes. Malar J 11: 122.[Crossref]
  31. Sharp BL, Kleinschmidt I, Streat E, Maharaj R, Barnes KI, Durrheim DN, Ridl FC, Morris N, Seocharan I, Kunene S, La Grange JJ, Mthembu JD, Maartens F, Martin CL, Barreto A, , 2007. Seven years of regional malaria control collaboration–Mozambique, South Africa, and Swaziland. Am J Trop Med Hyg 76: 4247.
  32. The Roll Back Malaria Partnership Adams H, Kunene S, Mouzin E, Novotny J, Phillips AA, , , 2012. Focus on Swaziland. Geneva, Switzerland: Roll Back Malaria Partnership Secretariat.
  33. Lengeler C, , 2004. Insecticide-treated bed nets and curtains for preventing malaria. Cochrane Database Syst Rev 2: CD000363.
  34. Pluess B, Tanser FC, Lengeler C, Sharp BL, , 2010. Indoor residual spraying for preventing malaria. Cochrane Database Syst Rev 4: CD006657.
  35. Mabaso ML, Sharp B, Lengeler C, , 2004. Historical review of malarial control in southern African with emphasis on the use of indoor residual house-spraying. Trop Med Int Health 9: 846856.[Crossref]
  36. Carter R, Mendis KN, Roberts D, , 2000. Spatial targeting of interventions against malaria. Bull World Health Organ 78: 14011411.
  37. Ghebreyesus TA, Witten KH, Getachew A, Yohannes AM, Tesfay W, Minass M, Bosman A, Teklehaimanot A, , 2000. The community-based malaria control programme in Tigray, northern Ethiopia. A review of programme set-up, activities, outcomes and impact. Parassitologia 42: 255290.
  38. Martens P, Hall L, , 2000. Malaria on the move: human population movement and malaria transmission. Emerg Infect Dis 103: 17.
  39. Kleinschmidt I, Sharp BL, Clarke GP, Curtis B, Fraser C, , 2001. Use of generalized linear mixed models in the spatial analysis of small-area malaria incidence rates in Kwazulu Natal, South Africa. Am J Epidemiol 153: 12131221.[Crossref]

Data & Media loading...

  • Received : 23 Nov 2015
  • Accepted : 31 Jan 2016

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error