Identifying Plasmodium falciparum transmission patterns through parasite prevalence and entomological inoculation rate

Monitoring malaria transmission is a critical component of efforts to achieve targets for elimination and eradication. Two commonly monitored metrics of transmission intensity are parasite prevalence (PR) and the entomological inoculation rate (EIR). Using geostatistical methods, we investigate the relationship between Plasmodium falciparum PR and EIR using data collected over 38 months in a rural area of Malawi. Our results indicate that hotspots identified through the EIR and PR partly overlapped during high transmission seasons but not during low transmission seasons. The estimated relationship showed a one-month delayed effect of EIR on PR such that at low transmission levels increases in EIR are associated with rapid rise in PR, but at high transmission levels, decreases in EIR do not translate into notable reductions in PR. Our study emphasises the need for integrated malaria control strategies that combines vector and human host managements monitored by both entomological and parasitaemia indices.