Households or hotspots? Defining intervention targets for malaria elimination in Ratanakiri Province, eastern Cambodia

Melanie Bannister-Tyrrell, Meryam Krit, Vincent Sluydts, Sochantha Tho, Mao Sokny, Vanna Mean, Saorin Kim, Didier Menard, Koen Peeters Grietens, Steven Abrams, Niel Hens, Marc Coosemans, Quique Bassat, Michael Boele van Hensbroek, Lies Durnez, Wim Van Bortel

Research output: Contribution to journalA1: Web of Science-articlepeer-review

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Background: Malaria "hotspots" have been proposed as potential intervention units for targeted malaria elimination. Little is known about hotspot formation and stability in settings outside sub-Saharan Africa.

Methods: Clustering of Plasmodium infections at the household and hotspot level was assessed over 2 years in 3 villages in eastern Cambodia. Social and spatial autocorrelation statistics were calculated to assess clustering of malaria risk, and logistic regression was used to assess the effect of living in a malaria hotspot compared to living in a malaria-positive household in the first year of the study on risk of malaria infection in the second year.

Results: The crude prevalence of Plasmodium infection was 8.4% in 2016 and 3.6% in 2017. Living in a hotspot in 2016 did not predict Plasmodium risk at the individual or household level in 2017 overall, but living in a Plasmodium-positive household in 2016 strongly predicted living in a Plasmodium-positive household in 2017 (Risk Ratio, 5.00 [95% confidence interval, 2.09-11.96], P < .0001). There was no consistent evidence that malaria risk clustered in groups of socially connected individuals from different households.

Conclusions: Malaria risk clustered more clearly in households than in hotspots over 2 years. Household-based strategies should be prioritized in malaria elimination programs in this region.

Original languageEnglish
JournalJournal of Infectious Diseases
Issue number6
Pages (from-to)1034-1043
Number of pages10
Publication statusPublished - 2019


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