Benny Rice, PhD

Associate Research Scholar, EEB, Princeton University

3. Pathogen Elimination: Why is Malaria Transmission Stubborn?

Global efforts to eliminate malaria as a public health problem are currently losing ground. Using Madagascar as a case study, we developed epidemiological studies [17–19] using extensive fieldwork in rural communities in Madagascar to deploy new molecular barcoding based approaches to malaria surveillance [12], quantify spatial variation in parasite prevalence at the household, community, and regional level [16] and characterize heterogeneity in Anopheles vector communities across ecological gradients [20]. Analysis is underway for a cohort study of 500 households - data collection finished in April 2023. Together, these studies give a detailed picture of the malaria epidemiology landscape, where localized, ‘sticky’ foci of elevated malaria transmission dominate the pattern and prevent progress towards malaria elimination.

Future empirical and theoretical work will focus on identifying how temporally confined events such as public health interventions (e.g., bednet campaigns), seasonality in human mobility and mosquito suitability, and extreme weather events (e.g., tropical cyclones) result in the spatial heterogeneity in malaria transmission observed. Madagascar, an ecologically diverse but isolated island, is an ideal setting to pursue this question. Among high burden malaria countries, Madagascar is uniquely susceptible to climatic events such as tropical cyclones providing opportunity to understand underlying linkages between climate and disease elimination.

12. Rice BL, Golden CD, Anjaranirina EJG, Botelho CM, Volkman SK, Hartl DL. Genetic evidence that the Makira region in northeastern Madagascar is a hotspot of malaria transmission. Malaria Journal. 2016;15: 596.
16. Rice BL, Golden CD, Randriamady HJ, Rakotomalala AANA, Vonona MA, Anjaranirina EJG, et al. Fine-scale variation in malaria prevalence across ecological regions in Madagascar: a cross-sectional study. BMC Public Health. 2021;21: 1018.
17. Golden CD, Anjaranirina EJG, Fernald LCH, Hartl DL, Kremen C, Milner DA Jr, Ralalason DH, Ramihantaniarivo H, Randriamady H, Rice BL, et al. Cohort Profile: The Madagascar Health and Environmental Research (MAHERY) study in north-eastern Madagascar. International Journal of Epidemiology. 2017;46: 1747–1748d.
18. Golden CD, Borgerson C, Rice BL, Allen LH, Anjaranirina EJG, Barrett CB, et al. Cohort Description of the Madagascar Health and Environmental Research-Antongil (MAHERY-Antongil) Study in Madagascar. Frontiers Nutrition. 2019;6: 109.
19. Golden CD, Rice BL, Randriamady HJ, Vonona AM, Randrianasolo JF, Tafangy AN, et al. Study Protocol: A Cross-Sectional Examination of Socio-Demographic and Ecological Determinants of Nutrition and Disease Across Madagascar. Frontiers Public Health. 2020;8: 500.
20. Arisco NJ, Rice BL, Tantely LM, Girod R, Emile GN, Randriamady HJ, et al. Variation in Anopheles distribution and predictors of malaria infection risk across regions of Madagascar. Malaria Journal. 2020;19: 348.

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