Open Access Research article

The receptive versus current risks of Plasmodium falciparum transmission in Northern Namibia: implications for elimination

Abdisalan M Noor12*, Petrina Uusiku4, Richard N Kamwi3, Stark Katokele4, Benson Ntomwa4, Victor A Alegana1 and Robert W Snow12

Author Affiliations

1 Malaria Public Health Department, Kenya Medical Research Institute-Wellcome Trust-University of Oxford Collaborative Programme, P.O. Box 43640, Nairobi, 00100 GPO, Kenya

2 Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, CCVTM, Oxford, OX 3 7LJ, UK

3 Office of the Minister, Ministry of Health and Social Services, Private Bag 13198, Windhoek, The Republic of Namibia

4 Directorate of Special Programmes, National Vector-borne Diseases Control Programme, Private Bag 13198, Windhoek, The Republic of Namibia

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BMC Infectious Diseases 2013, 13:184  doi:10.1186/1471-2334-13-184

Published: 23 April 2013

Abstract

Background

Countries aiming for malaria elimination need to define their malariogenic potential, of which measures of both receptive and current transmission are major components. As Namibia pursues malaria elimination, the importation risks due to cross-border human population movements with higher risk neighboring countries has been identified as a major challenge. Here we used historical and contemporary Plasmodium falciparum prevalence data for Namibia to estimate receptive and current levels of malaria risk in nine northern regions. We explore the potential of these risk maps to support decision-making for malaria elimination in Namibia.

Methods

Age-corrected geocoded community P. falciparum rate PfPR2-10 data from the period 1967–1992 (n = 3,260) and 2009 (n = 120) were modeled separately within a Bayesian model-based geostatistical (MBG) framework. A full Bayesian space-time MBG model was implemented using the 1967–1992 data to make predictions for every five years from 1969 to 1989. These maps were used to compute the maximum mean PfPR2-10 at 5 x 5 km locations in the northern regions of Namibia to estimate receptivity. A separate spatial Bayesian MBG was fitted to the 2009 data to predict current risk of malaria at similar spatial resolution. Using a high-resolution population map for Namibia, population at risk by receptive and current endemicity by region and population adjusted PfPR2-10 by health district were computed. Validations of predictions were undertaken separately for the historical and current risk models.

Results

Highest receptive risks were observed in the northern regions of Caprivi, Kavango and Ohangwena along the border with Angola and Zambia. Relative to the receptive risks, over 90% of the 1.4 million people across the nine regions of northern Namibia appear to have transitioned to a lower endemic class by 2009. The biggest transition appeared to have occurred in areas of highest receptive risks. Of the 23 health districts, 12 had receptive PAPfPR2-10 risks of 5% to 18% and accounted for 57% of the population in the north. Current PAPfPR2-10 risks was largely <5% across the study area.

Conclusions

The comparison of receptive and current malaria risks in the northern regions of Namibia show health districts that are most at risk of importation due to their proximity to the relatively higher transmission northern neighbouring countries, higher population and modeled receptivity. These health districts should be prioritized as the cross-border control initiatives are rolled out.