Spatial and temporal variation in malaria transmission in a low endemicity area in northern Tanzania

Background: Spatial and longitudinal monitoring of transmission intensity will allow better targeting of malaria interventions. In this study, data on meteorological, demographic, entomological and parasitological data over the course of a year was collected to describe malaria epidemiology in a single village of low transmission intensity. Methods: Entomological monitoring of malaria vectors was performed by weekly light trap catches in 10 houses. Each house in the village of Msitu wa Tembo, Lower Moshi, was mapped and censused. Malaria cases identified through passive case detection at the local health centre were mapped by residence using GIS software and the incidence of cases by season and distance to the main breeding site was calculated. Results: The principle vector was Anopheles arabiensis and peak mosquito numbers followed peaks in recent rainfall. The entomological inoculation rate estimated was 3.4 (95% CI 0.7 - 9.9) infectious bites per person per year. The majority of malaria cases (85/130) occurred during the rainy season (chi(2) = 62,3, p < 0.001). Living further away from the river ( OR 0.96, CI 0.92 - 0.998, p = 0.04 every 50 m) and use of anti-insect window screens ( OR 0.65, CI 0.44 - 0.94, p = 0.023) were independent protective factors for the risk of malaria infection. Children aged 1 - 5 years and 5 - 15 years were at greater risk of clinical episodes ( OR 2.36, CI 1.41 - 3.97, p = 0.001 and OR 3.68, CI 2.42 - 5.61, p < 0.001 respectively). Conclusion: These data show that local malaria transmission is restricted to the rainy season and strongly associated with proximity to the river. Transmission reducing interventions should, therefore, be timed before the rain-associated increase in mosquito numbers and target households located near the river.