Epidemiology of Malaria and Other Diseases of Public Health Importance and Implications for Interventions in High Transmission Settings in Sub-Saharan Africa

Infectious diseases remain a major cause of disability of death in low-resource settings. Malaria alone was responsible for an estimated 405,000 deaths globally in 2018, with the 94% of these deaths occurring in sub-Saharan Africa. In Mozambique and Democratic Republic of the Congo (DRC), communicable diseases, including malaria, lower respiratory infections, and neonatal disorders are among the top causes of disability and death. Understanding malaria and co-endemic diseases in these two countries can aid the planning, evaluation, and targeting of public health interventions. Additionally, studying the efficacy of the drugs used to treat malaria will preserve the ability for malaria cases to be treated successfully. The three studies in this dissertation describe the epidemiology of malaria and co-endemic diseases of public health importance in Mozambique and evaluate the efficacy of medicines used to treat malaria in DRC. The first study will describe the spatial epidemiology of malaria in two high-burden districts in northern Mozambique to explore the utility of exploration of local spatial heterogeneity in high-transmission settings. The second study will investigate patterns in antibody responses to several infectious pathogens of public health importance in Mozambique, providing an opportunity to understand common predictors of infectious diseases endemic in this region. The third study will examine the efficacy of three artemisinin-based combination therapies used to treat uncomplicated malaria and molecular markers of antimalarial resistance in five sites in DRC. Collectively, the three studies in this dissertation describe factors that have implications for intervention planning and disease surveillance in areas with high malaria and other tropical disease burden and limited health resources. Careful consideration of transmission setting can support more efficient and higher quality data collection and may allow for intervention design tailored to the local realities that can target multiple diseases of public health importance