In a cluster-randomized controlled trial, Amrish Baidjoe, Teun Bousema and colleagues investigate whether interventions targeted to malaria hotspots in Kenya can reduce transmission in surrounding areas. Investigating molecular and immunological signatures of malaria exposure in more than 17,000 inhabitants of the Kenyan highlands, they uncovered numerous small-scale hotspots of malaria transmission. Targeting these hotspots with mosquito control and drug-based interventions resulted in a significant but transient effect on malaria transmission. These findings indicate that areas where malaria transmission is widespread but includes hotspots might benefit most from an untargeted community-wide approach to malaria prevention.
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