ArticleInfectious diseases of poverty2023
Risk of imported malaria infections in Zanzibar: a cross-sectional study.
Article in Infectious diseases of poverty, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers.
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Who cites it
15 citing papers in PubMed, 18 citations in OpenAlex.
- Longitudinal surveillance of Anopheles mosquitoes across different settings in Tanga and Unguja: increased distribution of An. merus in coastal and inland areas of Tanzania.Malaria journal · 2026Article
- Imported malaria predominates in near-elimination settings in Southwestern Uganda.medRxiv : the preprint server for health sciences · 2026Article
- Imported malaria predominates in near-elimination settings in Southwestern Uganda.PLOS global public health · 2026Article
- Epidemiological and entomological analysis of imported malaria in Pemba Island, Zanzibar: a study from 2020-2022.Malaria journal · 2025Article
- Integrating mobility, travel survey, and malaria case data to understand drivers of malaria importation to Zanzibar, 2022-2023.Malaria journal · 2025Article
- Determinants of locally acquired malaria infections in Zanzibar: a cross-sectional study.Malaria journal · 2025Article
- Integrating mobility, travel survey, and malaria case data to understand drivers of malaria importation to Zanzibar, 2022-2023.medRxiv : the preprint server for health sciences · 2025Article
- Genetic surveillance reveals low but sustained malaria transmission with clonal replacement in Sao Tome and Principe.Communications medicine · 2025Article
- Early evening outdoor biting by malaria-infected Anopheles arabiensis vectors threatens malaria elimination efforts in Zanzibar.Malaria journal · 2025Article
- Article
- Regular Plasmodium falciparum importation onto Bioko Island, Equatorial Guinea, hampers malaria elimination from the island.PLOS global public health · 2025Article
- Comparison of fine-scale malaria strata derived from population survey data collected using RDTs, microscopy and qPCR in South-Eastern Tanzania.Malaria journal · 2024Article
- Geography and health: role of human translocation and access to care.Infectious diseases of poverty · 2024Article
- Upsurge in cases of travellers' malaria ex Zanzibar indicates that malaria is on the rebound in the archipelago.New microbes and new infections · 2024Article
- Multiplexed ddPCR-amplicon sequencing reveals isolated Plasmodium falciparum populations amenable to local elimination in Zanzibar, Tanzania.Nature communications · 2023Article
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Authors and funding
15 authors at 5 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundZanzibar has made substantial progress in malaria control with vector control, improved diagnosis, and artemisinin-based combination therapy. Parasite prevalence in the population has remained around 1% but imported infections from mainland Tanzania contribute to sustained local transmission. Understanding travel patterns between mainland Tanzania and Zanzibar, and the risk of malaria infection, may help to control malaria importation to Zanzibar.
methodsA rolling cross-sectional survey linked to routine reactive case detection of malaria was carried out in Zanzibar between May 2017 and October 2018. Households of patients diagnosed with malaria at health facilities were surveyed and household members were tested for malaria using rapid diagnostic tests and a sub-sample by quantitative PCR (qPCR). Interviews elicited a detailed travel history of all household members who had travelled within the past two months, including trips within and outside of Zanzibar. We estimated the association of malaria infection with travel destinations in pre-defined malaria endemicity categories, trip duration, and other co-variates using logistic regression.
resultsOf 17,891 survey participants, 1177 (7%) reported a recent trip, of which 769 (65%) visited mainland Tanzania. Among travellers to mainland Tanzania with travel destination details and a qPCR result available, 241/378 (64%) reported traveling to districts with a 'high' malaria endemicity and for 12% the highest endemicity category was 'moderate'. Travelers to the mainland were more likely to be infected with malaria parasites (29%, 108/378) than those traveling within Zanzibar (8%, 16/206) or to other countries (6%, 2/17). Among travellers to mainland Tanzania, those visiting highly endemic districts had a higher odds of being qPCR-positive than those who travelled only to districts where malaria-endemicity was classified as low or very low (adjusted odd ratio = 7.0, 95% confidence interval: 1.9-25.5). Among travellers to the mainland, 110/378 (29%) never or only sometimes used a mosquito net during their travel.
conclusionsStrategies to reduce malaria importation to Zanzibar may benefit from identifying population groups traveling to highly endemic areas in mainland Tanzania. Targeted interventions to prevent and clear infections in these groups may be more feasible than attempting to screen and treat all travellers upon arrival in Zanzibar.
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