Residual Malaria Transmission in Select Countries of Asia-Pacific Region: Old Wine in a New Barrel

Hii, Jeffrey, Hustedt, John, and Bangs, Michael (2021) Residual Malaria Transmission in Select Countries of Asia-Pacific Region: Old Wine in a New Barrel. Journal of Infectious Diseases, 223 (Suppl 2). S111-S142.

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Background: Despite substantial reductions in malaria burden and improvement in case management, malaria remains a major public health challenge in the Asia-Pacific region. Residual malaria transmission (RMT) is the fraction of total transmission that persists after achievement of full operational coverage with effective insecticide-treated bed nets (ITNs)/long-lasting insecticidal nets (LLINs) and/or indoor residual spray interventions. There is a critical need to standardize and share best practices for entomological, anthropological, and product development investigative protocols to meet the challenges of RMT and elimination goals.

Methods: A systematic review was conducted to describe when and where RMT is occurring, while specifically targeting ownership and usage of ITN/LLINs, indoor residual spray application, insecticide susceptibility of vectors, and human and vector biting behavior, with a focus on nighttime activities.

Results: Sixty-six publications from 1995 to present met the inclusion criteria for closer review. Associations between local vector control coverage and use with behaviors of human and mosquito vectors varied by locality and circumstance. Consequently, the magnitude of RMT is insufficiently studied and analyzed with sparse estimates of individual exposure in communities, insufficient or incomplete observations of ITN/LLIN use, and the local human population movement into and from high-risk areas.

Conclusions: This review identified significant gaps or deficiencies that require urgent attention, namely, developing standardized procedures and methods to estimate risk exposure beyond the peridomestic setting, analytical approaches to measure key human-vector interactions, and seasonal location-specific agricultural or forest use calendars, and establishing the collection of longitudinal human and vector data close in time and location.

Item ID: 70424
Item Type: Article (Research - C1)
ISSN: 1537-6613
Keywords: early outdoor mosquito biting, exophagy, human behavior, nighttime activity, Residual malaria transmission, universal or maximal coverage of ITN and IRS
Copyright Information: © World Health Organization, 2021. All rights reserved. The World Health Organization has granted the Publisher permission for the reproduction of this article. This is an Open Access article distributed under the terms of the Creative Commons Attribution 3.0 IGO License ( which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Date Deposited: 08 May 2022 23:46
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