Background
Methods
Protocol registration
Working definition of micro-epidemiology
Study design and setting
Outcome of interest
Independent variables of interest
Information sources and search
((malaria or Plasmodium or Anopheles [title/abstract]) and (‘micro-epidemiology’ or ‘microepidemiology’ or ‘micro epidemiology’ or ‘hotspot’ or ‘heterogeneity’ or ‘cluster*’ or ‘spatial cluster*’) and (‘malaria/epidemiology’ or ‘malaria/ethnology’ or ‘malaria/statistics and numerical data’ [mesh major topic]))
Study selection
Data collection process
Demographic
Social
Environmental
Medical history and genetic traits
Plasmodium and human population
Health seeking behaviour and access to care
Risk of bias in individual studies
Synthesis of results
Descriptive synthesis
Quantitative synthesis
Risk of bias across studies
Results
Study selection
Study characteristics (Table 1)
Study settings
Study | Study setting | Malaria species | Dominant vector(s) | Study design | Number of participants | Number of clusters | Infections (n, case-only studies), prevalence(%) or incidence | Spatial scale | Duration | Detection (diagnostic) | Units of analysis | Quality (max 9 stars)a
|
---|---|---|---|---|---|---|---|---|---|---|---|---|
Alemu et al. [20] | Dabat district, Ethiopian Highlands |
P. falciparum, P. vivax
| Not specified | Case control | 1644 | 4 health facilities | 645 | 1187.9 km2
| 10 months | PCD (RDT, LM) | Individual, cluster (hotspot) | ★★★★★★ |
Atieli et al. [23] | Western Kenyan Highlands |
P. falciparum
|
An gambiae
| Cross sectional | 480 households | 4 villages | 0.7–20.6% | 36 km2
| 1 month | Screening (LM) | Cluster (valley location) | ★★★★★★ |
Audibert et al. [14] | Logone Valley, Cameroon |
P. falciparum
| Not specified | Cross sectional (pre-post) | 716–1078 | 3 villages | 7.1–30.1% | 350 km2
| 5 years | Screening (LM) | Cluster (village) | ★★★★★★ |
Baragatti et al. [22] | Ouagadougou, Burkina Faso |
P. falciparum
|
An. gambiae
| Cross-sectional | 3354 | 8 villages | 22% | 144 km2
| 1 year | Screening (LM) | Individual, cluster (urban areas) | ★★★★★★★★ |
Barrera et al. [15] | Sucre State, Venezuela |
P. vivax
|
An. aquasalis curry
| Cohort | 8836 | 35 localities | Not reported | 51 km2
| 12 years | PCD (LM) | Cluster (village) | ★★★★★★★ |
Barros and Honario [41] | Rorainopolis settlement, Roraima Province, Brazil |
P. vivax
|
An. darlingi
| Cohort | 75 households | 1 settlement | 186 | 18.8 km road | 2.5 years | PCD (LM) | Household | ★★★★★ |
Basurko et al. [42] | Cacao village, French Guiana |
P. vivax
|
An. darlingi
| Cohort | 839 | 1 village | 359 | 1 km2
| 5 years | PCD (LM) | Individual | ★★★★ |
Bejon et al. [43] | Kilifi district, Kenya |
P. falciparum
|
An. gambiae
| Cohort | 1708 | 3 villages | 0.49–0.82 episodes/child/year | 450 km2
| 11 years | Screening, ACD (LM) | Household (homestead) | ★★★★★★★ |
Bousema et al. [2] | Korogwe district, Tanga Region, Tanzania |
P. falciparum
|
An. gambiae
| Cohort | 1276 | 15 villages | 399 | 400 km2
| 4 years | PCD (RDT) | Cluster (hotspot) | ★★★★★★ |
Brooker et al. [44] | Nandi district, Kenya |
P. falciparum
|
An. gambiae
| Case control | 284 | 3 villages | 129 | 144 km2
| 10 weeks | ACD (LM) | Individual | ★★★★★★★ |
Camargo et al. [45] | Urupa Farm, Rondonia, Brazil |
P. falciparum, P. vivax
|
An. darlingi
| Cohort | Average 170, varied seasonally | 1 settlement | 171 | 230 km2
| 2 years | Screening, PCD (LM) | Individual | ★★★★★★ |
Cattani et al. [16] | Villages around Madang, Papua New Guinea |
P. falciparum
| Not specified | Repeated cross sectional | ~16,500 in area | 6 villages | 41–89% | 900 km2
| 2 years | Screening (LM) | Cluster (village) | ★★★★★★★ |
Clark et al. [28] | Mulago III parish, Kampala, Uganda |
P. falciparum
|
An. gambiae
| Cohort | 558 | 1 village | 0.77 episodes/person/year | 1 km2
| 2 years | PCD (LM) | Individual | ★★★★★★★★★ |
Coulibaly et al. [46] | Bandiagara, Mali |
P. falciparum
|
An. gambiae
| Cohort | 300 | 1 village | 296 | 4 km2
| 1 year | Screening, PCD (LM) | Individual | ★★★★★ |
da Silva-Nunes et al. [24] | Pedro Peixoto settlement, Acre, Brazil |
P. falciparum, P. vivax
|
An. darlingi
| Cohort | 509 | 1 settlement | 15.5% by PCR, 5.2% by LM | 15 km2
| 2 years | Screening, ACD, PCD (LM, PCR) | Individual | ★★★★★★★ |
de Barros et al. [41] | Rorainopolis settlement, Roraima Province, Brazil |
P. vivax
|
An. darlingi
| Cohort | 333 | 1 settlement | 31% ≥1 episode | 18.8 km road | 2.5 years | PCD (LM) | Household | ★★★★★★★ |
Ernst et al. [47] | Kipsamoite, North Nandi district, Kenya |
P. falciparum
|
An. gambiae, An. funestus
| Cohort | 3700 | 7 villages | 41–127 episodes/1000 persons/year | 16 km2
| 4 years | PCD (LM) | Individual, household | ★★★★★★★ |
Florey et al. [26] | Kingwede village, Kenya |
P. falciparum, P. malariae, P. ovale
| Not specified | Cross-sectional | 561 | 1 village | 50.40% | 10 km2
| 3 months | Screening (PCR) | Individual | ★★★★★★★★ |
Gamage-Mendis et al. [48] | Kataragama area, Sri Lanka |
P. vivax, P. falciparum
|
An. subpictus, An. culicifacies
| Cohort | 3023 | 6 villages | 25.80% | 8 km2
| 17 months | PCD (LM) | Individual, household | ★★★★★ |
Gaudart et al. [49] | Bancoumana village, Mali |
P. falciparum, P. malariae, P. ovale
| Not specified | Cohort | 1101–1491 | 1 village | 47% | 2.5 km2
| 5 years | Screening (LM) | Individual | ★★★★★★★★★ |
Ghebreyesus et al. [50] | Tigray Region, Ethiopia |
P. vivax, P. falciparum
|
An. arabiensis
| Cohort | 2114 | 6 villages | Not reported | Not reported | 1 year | Screening (LM) | Individual | ★★★★★★★★ |
Grange et al. [27] | Dielmo village, Senegal |
P. falciparum
| Not specified | Cohort | 828 | 1 village | 898 gametocyte-positives in 297 individuals | Not reported | 19 years | Screening, ACD (LM) | Individual | ★★★★★★★ |
Grillet, Barrera et al. [17] | Caijigal Municipality, Sucre State, Venezuela |
P. vivax
|
An. aquasalis curry
| Cohort | 24,345 | 29 villages | 10-44 cases/1000 persons/year | 332.5 km2
| 7 years | ACD, PCD (LM) | Cluster (village) | ★★★★★★★★ |
Grillet, Jordan, et al. [18] | Caijigal Municipality, Sucre State, Venezuela |
P. vivax
|
An. aquasalis curry
| Cohort | 24,788 | 29 villages | 10-44 cases/1000 persons/year | 332.5 km2
| 7 years | ACD, PCD (LM) | Cluster (village) | ★★★★★ |
Gunawardena, et al. [51] | Kataragama area, Sri Lanka |
P. vivax, P. falciparum
|
An. culicifacies
| Cohort | 1744 | 8 villages | 0.91 cases/person/18 months | 26 km2
| 18 months | Screening, PCD (LM) | Household | ★★★★★ |
Haque, Glass et al. [52] | Gilachari Union, Rangamati district, Chittagong Hill Tracts |
P. falciparum
|
An. baimai, An. minimus, An. annularis
| Cohort | 7922 | 54 villages | 6.30% | 113.83 km2
| 2 years | PCD (RDT, LM) | Individual, household | ★★★★★★★ |
Haque, Magalhaes et al. [29] | Rajasthali sub-district, Chittagong Hill districts, Bangladesh |
P. falciparum, P. vivax
|
An. baimai, An. minimus, An. annularis
| Cross-sectional | 1400 | 109 villages | 11.50% | 145 km2
| <1 year | Screening (RDT) | Individual | ★★★★★★★★ |
Haque, Sunahara et al. [7] | Rajasthali sub-district, Chittagong Hill districts, Bangladesh |
P. falciparum, P. vivax
| Not specified | Cross sectional | 1400 | 109 villages | 11.50% | 250 km2
| 1 month | Screening (RDT) | Individual | ★★★★★★★★ |
Kreuels et al. [19] | Afigya-Sekyere district, Ashanti region, Ghana |
P. falciparum
|
An. gambiae, An. funestus
| Cohort | 535 | 9 villages | 67% individuals ≥1 episode | 200 km2
| 21 months | PCD (LM) | Individual, cluster (village) | ★★★★★★ |
Loha et al. [37] | Chano Mille kebele, Ethiopia |
P. falciparum, P. vivax
|
Not specified
| Cohort | 8121 | 1 village | 45.1 episodes/1000 persons/year | 2.4 km2
| 2 years | ACD, PCD (RDT, LM) | Individual, household | ★★★★★★★ |
Luxemburger et al. [53] | Karen refugee camp, Thailand |
P. falciparum, P. vivax
|
An. minimus, An. maculatus
| Cohort | 735 | 1 refugee camp | 4% | 2 km2
| 1 year | ACD, PCD (LM) | Individual | ★★★★★★★ |
Midega et al. [54] | Kilifi district, Kenya |
P. falciparum
|
An. gambiae
| Cohort | 642 | 338 homesteads | 14% by PCR, 0.7 episodes/child/year | 40 km2
| 1 year | Screening, ACD (LM) | Individual | ★★★★★★★★ |
Mosha et al. [6] | Misungwi district, Tanzania |
P. falciparum
|
An. gambiae
| Repeated cross sectional | 3426 | 4 villages | 49% | Not reported | 4 months | Screening (PCR, serology) | Individual | ★★★★★★★★ |
Mosha et al. [55] | Misungwi district, Tanzania |
P. falciparum
|
An. gambiae
| Cross sectional | 3057 | 4 villages | 35.20% | Not reported | 4 months | Screening (PCR) | Household | ★★★★★★★ |
Murhandarwati et al. [38] | Kokap subdistrict, Kulon Progo, Indonesia |
P. vivax, P. falciparum
|
An. maculatus, An. balabacensis, An. vagus
| Mixed methods | 42,264 | 5 villages | 0.50% | 90 km2
| 1 year | ACD, PCD (LM) | Individual | ★★ |
Ndiath et al. [56] | Keur Soce DHS site, Senegal |
P. falciparum
| Not specified | Cross sectional | 1614 | 74 villages | 12% | 312 km2
| 1 month | ACD (RDT) | Individual | ★★★★★★★★ |
Nixon et al. [57] | Wainyapu village, Sumba, Indonesia |
P. falciparum, P. vivax, P malariae
|
An. sundaicus, An. subpictus, An. vagus
| Cross sectional | 960 | 1 village | 25% | 22 km2
| 4 months | Screening (LM) | Individual | ★★★★★★★★ |
Olotu et al. [58] | Kilifi district, Kenya |
P. falciparum
|
An. gambiae
| Cohort | 2425 | 3 villages | 1.4 episodes/person/year | 450 km2
| 12 years | ACD, PCD (LM) | Individual | ★★★★★★ |
Parker et al. [59] | Thailand/Myanmar border |
P. vivax, P. falciparum, P. malariae
| Not specified | Cohort | Average 494 | 1 village | 75 | 0.16 km2
| 10 months | Screening (LM, PCR) | Individual | ★★★★★★★★ |
Peterson, Borrell et al. [60] | Kebele 11, Adama City, Ethiopia |
P. vivax, P. falciparum
|
An. arabiensis
| Cohort | 1367 | 1 kebele | 9% | 1.8 km2
| 4 months | PCD (LM) | Individual, household | ★★★★★★★ |
Prakash, Mohapatra, 2000 [21] | Nedeluajan village, Jorhat district, Assam, India |
P. falciparum, P. vivax
|
An. dirus, An. minimus
| Cross sectional | 701 | 3 sub-village clusters, 1 village | 16% | 1 km2
| 1 month | Screening (LM) | Individual, cluster (sub-village) | ★★★★★★ |
Pullan, Bukirwa et al. [61] | Mulanda sub-county, Tororo district, Uganda |
P. falciparum
|
Anophelees gambiae, An. funestus
| Cross sectional | 1844 | 4 villages | 39% | 7.5 km2
| 4 months | Screening (RDT) | Individual | ★★★★★★★★ |
Pullan, Kabatereine et al. [25] | Mulanda sub-county, Tororo district, Uganda |
P. falciparum, P. malariae
|
Anophelees gambiae, An. funestus
| Cross sectional | 1770 | 14 clusters, 4 villages | 39% | 7.5 km2
| 4 months | Screening (RDT) | Individual | ★★★★★★★★ |
Rosas-Aguirre, Ponce et al. [62] | Bellavista district, Sullana province, Peru |
P. vivax
|
An. albimanus
| Cross sectional, case control | 4650 | 3 neighbourhoods | 13% ≥1 episode | 3.1 km2
| 2 years | PCD (LM, PCR) | Household | ★★★★★ |
Rosas-Aguirre, Speybroeck et al. [63] | San Juan, Loreto region, Peru |
P. vivax, P. falciparum
|
An. darlingi
| Cross sectional | 651 | 3 communities | 3% by MS, 11% by PCR | 48 km road | 1 month | Screening (LM, PCR, serology) | Individual | ★★★★★★★★ |
Rulisa et al. [64] | Ruhuha Sector, Bugesera district, Rwanda |
P. falciparum
| Not specified | Cross sectional | 769 | 1 sector | 23% of self-reported fever cases | 54 km2
| 7 months | ACD, PCD (RDT) | Individual, household | ★★★★★★ |
Sissoko et al. [5] | Sotuba and Kolle villages, Mali |
P. falciparum
|
An. gambiae, An. funestus
| Cross sectional | 588 | 2 villages | 8–35% | 2 km2
| 6 months | Screening, PCD (LM) | Individual, cluster (hotspot) | ★★★★★★★ |
Trape et al. [65] | Pikine Ancien district, Dakar, Senegal |
P. falciparum, Plasmodium. malariae
|
An. arabiensis
| Repeated cross sectional | 2465 | 1 urban sub-district | 4% | 910 m transect | 9 months | Screening (LM) | Individual | ★★★★★★ |
van der Hoek et al. [66] | Mahameegaswewa village, Anuradhapura district, Sri Lanka |
P. vivax, P. falciparum
|
An. culicifacies
| Cohort | 280 | 1 village | 1.5 episodes/person/year | 1 village | 11 months | ACD (LM) | Individual | ★★★★★★★★ |
Winskill et al. [67] | Muheza district, Tanga region, Tanzania |
P. falciparum
|
An. gambiae sl
| Cross sectional | 1438 | 21 hamlets, 5 villages | 15% | 300 km2
| Not specified | Screening (LM) | Individual | ★★★★★★★★ |
Ye et al. [4] | Kossi province, Burkina Faso |
P. falciparum
| Not specified | Cohort | 867 | 3 villages, 1 town | 787.6 episodes/person/year | 19–44 km between villages | 1 year | ACD (LM) | Individual, cluster (village) | ★★★★★★★★ |
Spatial scales of micro-epidemiological studies of malaria
Units of analysis
Risk factors for malaria in micro-epidemiological studies
Demographic factors
Variables included as risk factors for malaria in 51 studies | Studies including this variable | Significant association reported |
---|---|---|
Demographic factors
| ||
Age | ||
Gender | ||
Ethnicity | ||
Income/wealth status | ||
Occupation | ||
Educational level | ||
Migrant status | ||
Citizenship status | [59] | [59] |
Marital status | [60] | |
Social factors
| ||
Number of sleeping rooms in house | [50] | |
Number of occupants per sleeping room | ||
Household dependency ratio | [60] | |
Presence of household guests | [60] | |
Individual bed net ownership/use | ||
Household bed net ownership/use | ||
Use of coils, repellent, fumigants to deter vectors | [66] | |
Recent travel away from primary residence | ||
Outdoor occupation | ||
Household member in outdoor occupation | ||
Evening outdoor activities | [26] | |
Dawn activities | [38] | |
Water contact behaviours (e.g. fishing, bathing) | [24] | |
Environmental factors
| ||
Housing construction quality | ||
House roofing material | ||
House wall material | ||
House floor material | ||
Presence/type of eaves | ||
Presence/type of windows | ||
Separate kitchen | [50] | |
House size (spatial area) | [67] | |
Household water source | [62] | |
House treated with indoor residual spraying | ||
Household Solid and liquid waste disposal | ||
Household surroundings (garden, litter, tidiness) | [60] | |
Proximity to vector breeding site | ||
Proximity to water body (e.g. pond, lake, swamp, stream) | ||
Proximity to man-made water storage and management (well, drain, piped water, brickworks) | ||
Proximity to forest | ||
Local forest density | ||
Proximity to agriculture (e.g. rice irrigation, tea plantation) | ||
Vector breeding site density | [2] | |
Direction of nearest vector breeding site | [54] | [54] |
Number of households on path to breeding site | [37] | |
Adult vector density | ||
Exposure to infectious biting mosquitoes | [2] | [2] |
Domestic animals kept in/near house | ||
House location | [24] | |
Proximity to main road | ||
Proximity to neighbouring houses/housing density | ||
Proximity to periphery of village/cluster
| ||
Village/cluster location | ||
Land cover type/vegetation index/ecological zone | [54] | |
Altitude/elevation | ||
Slope/aspect | ||
Topography (valley shape, wetness index, convergence index) | [23] | |
Temperature | [43] | |
Rainfall | [15] | |
Humidity | ||
Season | ||
Medical history and genetic factors
| ||
Previous malaria episodes | ||
Duration of residence in malaria-endemic region | [45] | |
Antibody titres, incl AMA-1, MSP-2, MSP-1_19 | ||
Fever history | [21] | |
Recent malaria treatment | [26] | |
Sickle cell trait | [28] | |
G6PD deficiency | [28] | [28] |
Hookworm infection | [25] | [25] |
Schistosomiasis infection | [26] | [26] |
ABO blood group | [27] | [27] |
Underweight/BMI | [44] | |
Pregnancy status | [60] | |
Birth season (for infants and young children) | [19] | [19] |
Plasmodium and human population factors
| ||
Household malaria cases | [64] | |
Local malaria prevalence | ||
Malaria prevalence in neighbouring localities | ||
Household size/household crowding | ||
Village population size/density | ||
Health seeking behaviour and access to care
| ||
Level of malaria knowledge | [26] | |
Malaria medicine kept at home | [44] | [44] |
Distance/access to health facility | ||
Access to malaria control program | ||
Use of traditional medicine | [38] |