Assessing the intrinsic and extrinsic drivers and targeting the observed resilience of malaria in northwestern and southern Tanzania: A protocol for a cross-sectional exploratory study

Background Despite high coverage and successes in malaria control strategies, some areas of Tanzania have indicated stagnantion or revesal of malaria burden. In malaria research, most studies are designed to assess drivers of malaria transmission focusing only on one dimension, single location while very few studies assess multiple components and their interactions at once. This article describes the protocol used to assess intrinsic and extrinsic drivers of persistent malaria transmission (hotsposts) in four regions from northwestern (Geita and Kigoma) and southern (Ruvuma and Mtwara) Tanzania. Methods This cross-sectional study was conducted between July and November 2017 in eight districts (two from each region). Based on the health facilities records, two villages were selected from each district. The study assessed five components individually and their linkages: socio-economic and malaria risk factors, parasitological, entomological, socio-anthropological and health system factors. Households (HHs) and household members were enumerated, socio-economic status and risk factors associated with malaria transmission were assessed. A total of 120 HHs were sampled from each village where malaria testing using rapid test and microscopy were done and blood spots on filter papers for genetic studies were collected. Heads of HHs were interviewed to capture information on knowledge, attitude, practice and beliefs towards malaria and its control. Assessment of adult mosquitoes in 25 HHs in each village and complimented with assessment of immature mosquitoes through larvae was conducted. The performance of the health system was assessed with respect to Information on availability, accessibility, affordability and quality of malaria prevention and case management services were collected from these health facilities. Discussion The proposed analysis plan and results from this study are expected to determine factors potentially responsible for persistence of malaria (hotspots) in the study areas. Rather than the traditional methodology of focusing on one metric, the approach proposed here triangulates observations from all five components, highlighting understanding of potential drivers while studying their complex interactions and map spatial heterogeneity. This study will provide an important framework and data which will guide future studies and malaria surveillance in Tanzania and other malaria endemic countries.