title: Molecular malaria epidemiology: mapping and burden estimates for the Democratic Republic of the Congo, 2007.
abstract: BACKGROUND
  Epidemiologic data on malaria are scant in many high-burden countries including the Democratic Republic of the Congo (DRC), which suffers the second-highest global burden of malaria. Malaria control efforts in regions with challenging infrastructure require reproducible and efficient surveillance. We employed new high-throughput molecular testing to characterize the state of malaria control in the DRC and estimate childhood mortality attributable to excess malaria transmission.
  
  
  RESULTS
  The Demographic and Health Survey was a cross-sectional, population-based cluster household survey of adults aged 15-59 years in 2007 employing structured questionnaires and dried blood spot collection. Parasitemia was detected by real-time PCR, and survey responses measured adoption of malaria control measures and under-5 health indices. The response rate was 99% at the household level, and 8,886 households were surveyed in 300 clusters; from 8,838 respondents molecular results were available. The overall prevalence of parasitemia was 33.5% (95% confidence interval [C.I.] 32-34.9); P. falciparum was the most prevalent species, either as monoinfection (90.4%; 95% C.I. 88.8-92.1) or combined with P. malariae (4.9%; 95% C.I. 3.7-5.9) or P. ovale (0.6%; 95% C.I. 0.1-0.9). Only 7.7% (95% CI 6.8-8.6) of households with children under 5 owned an insecticide-treated bednet (ITN), and only 6.8% (95% CI 6.1-7.5) of under-fives slept under an ITN the preceding night. The overall under-5 mortality rate was 147 deaths per 1,000 live births (95% C.I. 141-153) and between clusters was associated with increased P. falciparum prevalence; based on the population attributable fraction, 26,488 yearly under-5 deaths were attributable to excess malaria transmission.
  
  
  CONCLUSIONS
  Adult P. falciparum prevalence is substantial in the DRC and is associated with under-5 mortality. Molecular testing offers a new, generalizable, and efficient approach to characterizing malaria endemicity in underserved countries.
authors.affiliation: Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America. stevemyertaylor@gmail.com
authors.forename: Steve M
authors.initials: SM
authors.lastname: Taylor
authors.forename: Jane P
authors.initials: JP
authors.lastname: Messina
authors.forename: Carla C
authors.initials: CC
authors.lastname: Hand
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Juliano
authors.forename: Jeremie
authors.initials: J
authors.lastname: Muwonga
authors.forename: Antoinette K
authors.initials: AK
authors.lastname: Tshefu
authors.forename: Benjamin
authors.initials: B
authors.lastname: Atua
authors.forename: Michael
authors.initials: M
authors.lastname: Emch
authors.forename: Steven R
authors.initials: SR
authors.lastname: Meshnick
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003430:Cross-Sectional Studies; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D005191:Family Characteristics; D006801:Humans; D008288:Malaria / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology*; D008875:Middle Aged; D025202:Molecular Diagnostic Techniques; D017720:Molecular Epidemiology / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends; D009026:Mortality; D010963:Plasmodium falciparum; D011159:Population Surveillance / Q000379:methods*