# Epidemiology of Malaria Risk in Malawi: Vector Resistance, ITNS, and Human Behavior

> **NIH NIH U19** · MICHIGAN STATE UNIVERSITY · 2021 · $156,315

## Abstract

Despite widespread anti-malaria interventions throughout Malawi, including country-wide distribution of
insecticide treated nets (ITNs) and free treatment, the burden of malaria remains extremely high, with no
measurable decrease in incidence of infection or disease over the past decade. Many factors have been
hypothesized to explain such intransigence of malaria in Malawi, and in many parts of sub-Saharan Africa,
such as unavailable treatment, drug resistance, improper diagnosis, "silent" reservoirs of infection, and failure
of prevention measures. This project, which is integrated with two others in the Malawi ICEMR, addresses the
epidemiology of disease risk from the perspective of human-vector interactions as influenced by ITN use and
effectiveness and insecticide resistance (IR). We have designed systematic studies to understand why the
burden of malaria remains high in Malawi, despite such intense efforts to reduce infection and disease. Our
previous work in Malawi has shown that IR is high among major vectors such as Anopheles funestus, and that
these mosquitoes are biting before and after usual sleeping time when ITNs could be useful. We hypothesize
that ITN effectiveness will vary based on the intensity of transmission, IR, and human and mosquito behaviors.
Hence, the goals of this proposed research are:
 1) Understand how human infection and disease risk changes with ITN use and effectiveness across
 diverse environmental contexts and vector-human contact scenarios,
 2) Determine how Plasmodium infection in vectors and humans varies with pyrethroid IR and vector
 behavior across three levels transmission intensity, and
 3) Evaluate how human behaviors and biting behavior of Anopheles species alter the entomological
 inoculation rate (EIR) and human disease risk.
To broach these objectives, we will undertake cohort-based, field studies of human and vector populations,
measuring infection and disease incidence before, during and after the 2018 Malawi ITN mass distribution
campaign. This effort allows us to evaluate the impacts of a massive "experimental" intervention by monitoring
effectiveness of interventions and any changes in disease risk. Two cohorts will be established around a
government health center in each of the three ecologically and epidemiologically different study sites. The
infection cohort will allow measurement of incidence of P. falciparum infection and the disease cohort will be
used to assess the incidence of malaria illness. By understanding these factors and their interactions across a
range of endemic transmission settings, critical intervention failures can be identified and new strategies to
prevent malaria designed. Our results should help improve intervention effectiveness in Malawi, and many
other settings in sub-Saharan Africa where malaria burden remains high despite concerted efforts.

## Key facts

- **NIH application ID:** 10133510
- **Project number:** 5U19AI089683-12
- **Recipient organization:** MICHIGAN STATE UNIVERSITY
- **Principal Investigator:** Don P Mathanga
- **Activity code:** U19 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $156,315
- **Award type:** 5
- **Project period:** 2010-07-01 → 2024-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10133510

## Citation

> US National Institutes of Health, RePORTER application 10133510, Epidemiology of Malaria Risk in Malawi: Vector Resistance, ITNS, and Human Behavior (5U19AI089683-12). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10133510. Licensed CC0.

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