EPPIcenter program, Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, United States
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
Anna Chen
EPPIcenter program, Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, United States
EPPIcenter program, Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, United States
Jordan Wilheim
EPPIcenter program, Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, United States
Anna-Rosa Mupiri
Multidisciplinary Research Center, University of Namibia, Windhoek, Namibia
Nick W Ruktanonchai
WorldPop Project, Geography and Environment, University of Southampton, Southampton, United Kingdom
Victor A Alegana
Multidisciplinary Research Center, University of Namibia, Windhoek, Namibia; WorldPop Project, Geography and Environment, University of Southampton, Southampton, United Kingdom
Andrew J Tatem
WorldPop Project, Geography and Environment, University of Southampton, Southampton, United Kingdom
Munyaradzi Tambo
Multidisciplinary Research Center, University of Namibia, Windhoek, Namibia
Bradley Didier
Clinton Health Access Initiative, Boston, United States
Justin M Cohen
Clinton Health Access Initiative, Boston, United States
Adam Bennett
Malaria Elimination Initiative, Institute of Global Health Sciences, University of California, San Francisco, San Francisco, United States
Hugh JW Sturrock
Malaria Elimination Initiative, Institute of Global Health Sciences, University of California, San Francisco, San Francisco, United States
Roland Gosling
Multidisciplinary Research Center, University of Namibia, Windhoek, Namibia; Malaria Elimination Initiative, Institute of Global Health Sciences, University of California, San Francisco, San Francisco, United States
Michelle S Hsiang
Malaria Elimination Initiative, Institute of Global Health Sciences, University of California, San Francisco, San Francisco, United States; Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, United States; Department of Pediatrics, UCSF Benioff Children's Hospital, San Francisco, United States
Institute for Health Metrics and Evaluation, University of Washington, Seattle, United States
Davis R Mumbengegwi
Multidisciplinary Research Center, University of Namibia, Windhoek, Namibia
Jennifer L Smith
Malaria Elimination Initiative, Institute of Global Health Sciences, University of California, San Francisco, San Francisco, United States
Bryan Greenhouse
EPPIcenter program, Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, United States; Chan Zuckerberg Biohub, San Francisco, United States
Local and cross-border importation remain major challenges to malaria elimination and are difficult to measure using traditional surveillance data. To address this challenge, we systematically collected parasite genetic data and travel history from thousands of malaria cases across northeastern Namibia and estimated human mobility from mobile phone data. We observed strong fine-scale spatial structure in local parasite populations, providing positive evidence that the majority of cases were due to local transmission. This result was largely consistent with estimates from mobile phone and travel history data. However, genetic data identified more detailed and extensive evidence of parasite connectivity over hundreds of kilometers than the other data, within Namibia and across the Angolan and Zambian borders. Our results provide a framework for incorporating genetic data into malaria surveillance and provide evidence that both strengthening of local interventions and regional coordination are likely necessary to eliminate malaria in this region of Southern Africa.
