Summary/Abstract Despite augmented control efforts, the burden of malaria remains high in many African countries, including Uganda. There is a great need to better target existing and new control interventions in an ever-changing landscape, but to do so improved surveillance is needed. Indeed, malaria surveillance, which encompasses monitoring and evaluation of malaria control efforts, is not only critical for the planning, implementation, and evaluation of control activities, but is considered a core intervention itself. This application is for continued funding of our PRISM program which has been collecting high quality malaria surveillance data from selected government-run health facilities around Uganda and from cross-sectional surveys in target areas surrounding these health facilities in collaboration with the National Malaria Control Division. We hypothesize that, in contrast to “routine” malaria surveillance that relies largely on aggregate health facility-based data and infrequent national malaria indicator surveys, our targeted and comprehensive approach will allow for more timely and accurate estimates of impact to better inform policy decision making. Our specific aims will be as follows: Aim 1. To conduct enhanced malaria surveillance at selected health facilities across Uganda. Leveraging an existing health facility-based network, high quality individual level data will be collected electronically from all outpatients who present to 42 facilities on a continuous basis. These data will be used to monitor trends in malaria morbidity, assess malaria case management practices, and provide data and samples for the resistance and molecular epidemiology projects of this program. Aim 2. To perform cross- sectional household surveys in target areas around each selected health facility. Repeated cross- sectional surveys will be conducted in randomly selected households from enumerated target areas to collect data on demographics, coverage levels of malaria control interventions, health seeking behavior, laboratory assessments, and entomological indicators, and samples from representative community members. These data and samples will be used to monitor community level trends in coverage and utilization of malaria control interventions and measures of endemicity, enabling studies of the resistance and molecular epidemiology projects. Aim 3. To assess the impact of population level malaria control interventions. Working with the Uganda NMCD and other implementing partners, we will design a series of studies to quantify the impact of existing and new malaria control interventions including LLINs, IRS, SMC and RTS,S. Study designs will be pragmatic and include the completion of an on-going cluster randomized trial studying LLINs, and quasi- experimental and “before and after” studies. These studies will utilize data from the health facility and community-based surveillance network described above to provide an efficient means of generating outcom...