Mharakurwa Sungano, Mbwana Natasha, Mharakurwa Trish, Karumbidza Thelma, Mathe Vuyisile, Fusire Punha, Tangwena Andrew, Chauke Wilson, Mukuzunga Munyaradzi, Dhliwayo Patience, Munyati Shungu Mtero, Gwanzura Lovemore, Bailey Jeffrey A, Moss William J
Africa University, Old Mutare, Mutare, Zimbabwe.
Manicaland Provincial Medical Directorate, Ministry of Health and Child Care, Mutare, Zimbabwe.
Malar J. 2025 Jul 28;24(1):245. doi: 10.1186/s12936-025-05494-4.
Mutare city of Zimbabwe was considered free of autochthonous malaria, until 2017, when the Ministry of Health and Child Care formally confirmed escalating cases of locally transmitted malaria in the city. The current study examined the risk factors for malaria cases in the city to aid in formulation of targeted intervention packages for helping restore malaria-free status.
The study employed complementary cross-sectional and case-control designs to ascertain the magnitude and risk factors of urban malaria cases presenting at all eight primary health care facilities of Mutare city from 2022 to 2023. Malaria cases were enrolled as confirmed by RDT or microscopy on presenting all-age symptomatic suspected malaria patients. Controls were similarly enrolled as all-age symptomatic suspected malaria patients found negative by both RDT and microscopy. All cases and controls were enrolled as representative of the presenting population with no matching. Data were analysed for descriptive and prevalence statistics, as well as risk factors, using SPSS Faculty version 27.
In a multivariate binary logistic model, significant risk factors for malaria cases found in the city included residential locale (RR [95%CI]: 3 [1.1-5.8], p = 0.029, N = 7,222), household proximity to still surface water pools or unprotected wells (16 [3.8-67.5], p < 0.001) and travel history in the past 2 weeks (9 [5.2-14.4], p < 0.001, N = 7,222), modal travel destinations being malaria-endemic adjoining districts within Zimbabwe, as well as areas of neighbouring Mozambique, mainly for trade or work. By far the most predominant risk factor for malaria cases was artisanal mining (RR [95%CI]: 22 [10.7-44.1], p < 0.001), which was 93% dominated by men, and male residents exhibited four-fold higher odds of being malaria cases than females (4 [2.0-6.5]).
Significant risk factors for urban malaria were found that were consistent with both autochthonous transmission and imported malaria in Mutare city. Environmental management and the deployment and concomitant promotion of mass ITNs, personal protection and other intervention packages, especially targeting communities exposed to the identified risk factors, would be instrumental towards re-establishing urban malaria elimination from Mutare city.
津巴布韦的穆塔雷市曾被认为没有本地疟疾，直到2017年，卫生和儿童保健部正式确认该市本地传播的疟疾病例不断增加。本研究调查了该市疟疾病例的风险因素，以协助制定有针对性的干预措施，帮助恢复无疟疾状态。
本研究采用互补的横断面和病例对照设计，以确定2022年至2023年在穆塔雷市所有八家初级卫生保健机构就诊的城市疟疾病例的规模和风险因素。疟疾病例通过快速诊断试验（RDT）或显微镜检查确诊，纳入所有年龄段有症状的疑似疟疾病人。对照同样纳入所有年龄段有症状的疑似疟疾病人，这些人经RDT和显微镜检查均为阴性。所有病例和对照均作为就诊人群的代表纳入，不进行匹配。使用SPSS专业版27对数据进行描述性和患病率统计分析以及风险因素分析。
在多变量二元逻辑模型中，该市疟疾病例的显著风险因素包括居住地点（相对风险[95%置信区间]：3[1.1 - 5.8]，p = 0.029，N = 7222）、家庭靠近静止的地表水池或无保护的水井（16[3.8 - 67.5]，p < 0.001）以及过去2周内的旅行史（9[5.2 - 14.4]，p < 0.001，N = 7222），出行目的地主要是津巴布韦境内疟疾流行的毗邻地区以及邻国莫桑比克的一些地区，主要是为了贸易或工作。到目前为止，疟疾病例最主要的风险因素是手工采矿（相对风险[95%置信区间]：22[10.7 - 44.1]，p < 0.001），其中93%为男性，男性居民患疟疾病例的几率是女性的四倍（4[2.0 - 6.5]）。
在穆塔雷市发现了与本地传播和输入性疟疾均相符的城市疟疾显著风险因素。环境管理以及大规模分发长效驱虫蚊帐、个人防护和其他干预措施的部署及推广，尤其是针对暴露于已确定风险因素的社区，将有助于在穆塔雷市重新实现消除城市疟疾的目标。
