Mozambique is a country in Southern Africa with around 30 million inhabitants. Malaria is the leading cause of mortality in the country. According to the WHO, Mozambique has the third highest number of malaria cases in the world, representing approximately 5% of the world total cases. Sussundenga District has the highest incidence in the Manica province and environmental conditions are the major contributor to malaria transmission. There is a lack of malaria risk maps to inform transmission dynamics in Sussundenga village. This study develops a malaria risk map for Sussundenga Village in Mozambique and identifies high risk areas to inform on appropriate malaria control and eradication efforts. One hundred houses were randomly sampled and tested for malaria in Sussundenga Rural Municipality. To construct the map, a spatial conceptual model was used to estimate risk areas using ten environmental and anthropic factors. Data from Worldclim, 30 × 30 Landsat images were used, and layers were produced in a raster data set. Layers between class values were compared by assigning numerical values to the classes within each layer of the map with equal rank. Data set input was classified, using diverse weights depending on their appropriateness. The reclassified data outputs were combined after reclassification. The map indicated a high risk for malaria in the northeast and southeast, that is, the neighborhoods of Nhamazara, Nhamarenza, and Unidade. The central eastern areas, that is, 25 de Junho, 1 and 2, 7 de Abril, and Chicueu presented a moderate risk. In Sussundenga village there was 92% moderate and 8% high risk. High malaria risk areas are most often located in densely populated areas and areas close to water bodies. The relevant findings of this study can inform on effective malaria interventions.

Malaria is one of the leading causes of morbidity and mortality in Mozambique, which has the fifth highest prevalence in the world. Sussundenga District in Manica Province has documented high P. falciparum incidence at the local rural health center (RHC). This study’s objective was to analyze the P. falciparum temporal variation and model its pattern in Sussundenga District, Mozambique. Data from weekly epidemiological bulletins (BES) was collected from 2015 to 2019 and a time-series analysis was applied. For temporal modeling, a Box-Jenkins method was used with an autoregressive integrated moving average (ARIMA). Over the study period, 372,498 cases of P. falciparum were recorded in Sussundenga. There were weekly and yearly variations in incidence overall (p < 0.001). Children under five years had decreased malaria tendency, while patients over five years had an increased tendency. The ARIMA (2,2,1) (1,1,1) 52 model presented the least Root Mean Square being the most appropriate for forecasting. The goodness of fit was 68.15% for malaria patients less than five years old and 73.2% for malaria patients over five years old. The findings indicate that cases are decreasing among individuals less than five years and are increasing slightly in those older than five years. The P. falciparum case occurrence has a weekly temporal pattern peaking during the wet season. Based on the spatial and temporal distribution using ARIMA modelling, more efficient strategies that target this seasonality can be implemented to reduce the overall malaria burden in both Sussundenga District and regionally.

BackgroundMalaria is still one of the leading causes of mortality and morbidity in Mozambique with little progress in malaria control over the past 20 years. Sussundenga is one of most affected areas. Malaria transmission has a strong association with environmental and socio-demographic factors. The knowledge of sociodemographic factors that affects malaria, may be used to improve the strategic planning for its control and, such studies do not exist in Sussundenga. Hence, the objective of this study is to model the relationship between malaria and sociodemographic factors in Sussundenga, Mozambique. MethodsHouses in the study area were digitalized and enumerated using GoogleEarth ProTM. Hundred houses were randomly selected to conduct a community survey of P. falciparum parasite prevalence using rapid diagnostic test (RDT). During the survey, a questionnaire was conducted to assess the socio-demographic factors of the participants. Descriptive statistics were analyzed and backward stepwise logistic regression was performed establishing a relationship between positive cases and the factors. The analysis was carried out using SPSS version 20 package. ResultsThe overall P. falciparum prevalence was 31.6 %. Half of the malaria positive cases occurred in age group 5 to 14 years. Previous malaria treatment, population density and age group were significant predictors for the model. The model explained 13.5 % of the variance in malaria positive cases and sensitivity of the final model was 73.3 %. ConclusionIn this area the highest burden of P. falciparum infection was among those t5-14 years old. Malaria infection was related to socio-demographic factors. Targeting malaria control at community level can contributed better than waiting for cases at health centers. These finding can be used to guide more effective interventions in this region.Trial registrationReview Board (IRB) at the University of Minnesota STUDY00007184 CNBS [IRB00002657]

Background Impacts of nationally directed malaria control interventions hinge on understanding malaria transmission and prevention at the community level. The decision to seek care or health-seeking behaviours provide valuable insight on knowledge of malaria, access to care, and efficacy of malaria case management. Thus far, few studies have focused on central Mozambique. The aim was to describe community level Plasmodium falciparum prevalence and health-seeking behaviours among residents of Sussundenga, Mozambique, a rural village in Manica Province with high malaria incidence reported at the Sussundenga-Sede health centre (RHC). Methods A cross-sectional community-based survey was conducted from December 2019 to February 2020. A random household sampling method was used, based on enumerated households from satellite imagery. All consenting participants completed a survey about malaria risk, prevention, and health-seeking behaviours, and received a P. falciparum malaria rapid diagnostic test (RDT). Results The study enrolled 358 individuals from 96 households. The P. falciparum prevalence was 31.6% (95% CI [26.6–36.5%]). Ninety-three percent of participants reported using the Sussundenga-Sede RHC for healthcare. Sixty-six percent of participants (N = 233) experienced at least one malaria symptom in the past month, with self-reported fever most frequently reported (19.3%). Of these, 176 (76.5%) sought care in a health facility and 174 (79%) received an RDT with 130 (63%) having a positive test. Of those with a positive RDT, 127 (97%) received artemether-lumefantrine. Following treatment, 123 (97%) participants’ symptoms resolved within a median of 3 days (IQR: 3–5) ranging from 2 to 14 days. In this high transmission setting, a high proportion of participants recognized malaria related symptoms then received a proper diagnostic test and treatment in a health facility. Conclusions Future interventions that leverage this health-seeking behaviour and strengthen health systems for community interventions will improve malaria control and inform the efficacy of potential interventions at this particular international border.

Malaria is still one of the leading causes of mortality and morbidity in Mozambique with the 5 th highest prevalence in the world, with little progress in malaria control over the past 20 years. Sussundenga village is one of most affected areas, and lies along the Zimbabwe border, making evaluation of malaria transmission and control policies integral for regional efforts. The objective of this study was to map and quantify malaria parasite prevalence and model its relationship with sociodemographic and economic traits in Sussundenga Village. Houses in the study area were digitalized and enumerated using GoogleEarth Pro TM . A sample of 125 houses was drawn to conduct a community survey of P. falciparum parasite prevalence using rapid diagnostic test (RDT). During the survey, a questionnaire was conducted to assess the socio-demographic and economic traits of the participants. Descriptive statistics were analyzed and logistic regression was performed to establish the relationship between positive cases and the traits. Using GIS a map the prevalence of malaria was produced. The analysis was carried out using SPSS version 20 package and ArcGis 10.7.1. 358 participants were enrolled, completed the survey, and were tested for malaria. The overall P. falciparum prevalence was 31.6 % and spatiality identified. Half of the malaria positive cases occurred in age group 5 to 14, 40 % more than expected and age group over 24 accounted for 17.6 % the cases, around 50 % less than expected. The model explained 15 % of the variance in malaria positive cases and sensitivity of the final model was 91.8 %. The increase in malaria treated cases, having paid employment, education level and age category, will decrease the probability of malaria positive cases in Sussundenga Village. Conclusion In this area the highest burden of P. falciparum infection was among those 5-14 years old. Malaria infection was related to socio-demographic and economic traits. Targeting malaria control at community level can contributed better than waiting for cases at health centers. These finding can be used to guide more effective interventions in this region.