BACKGROUND: Monitoring and evaluation of @entity311 programmes may require a combination of approaches to detect any effects of control. This is particularly true at lower transmission levels where detecting both @entity281 and exposure to @entity281 will provide additional evidence of any change. This paper describes use of three transmission metrics to explore the @entity311 epidemiology in the highlands of western Kenya. METHODS: A malariometric survey was conducted in June 2009 in two highland districts, Kisii and Rachuonyo South, Nyanza Province, Kenya using a cluster design. Enumeration areas were used to sample 46 clusters from which 12 compounds were randomly sampled. Individuals provided a finger-blood sample to assess @entity281 ( @entity1062 , PCR) and exposure (anti-Plasmodium falciparum MSP-1 antibodies) and a questionnaire was administered to record household factors and assess use of vector control interventions. RESULTS: Malaria prevalence @entity281 rates were 3.0  % (95  % CI 2.2-4.2  %) by @entity1062 ( @entity1062 ) and 8.5  % (95  % CI 7.0-10.4  %) by PCR and these ranged from 0-13.1 to 0-14.8  % between clusters for @entity1062 and PCR, respectively. Seroprevalence was 36.8  % (95  % CI 33.9-39.8) ranging from 18.6 to 65.8  %. Both @entity1062 and PCR prevalences were highest in @entity1 aged 5-10 years but the proportion of infections that were sub-patent was highest in those between 15 and 20  years of age (78.1  %, 95  % CI 63.0-93.3  %) and those greater than 20  years (73.3  %, 95  % CI 64.5-81.9  %). Those reporting both indoor residual spraying (IRS) in their home and use of bed nets had lower exposure to @entity311 compared to those who reported using IRS or bed nets alone. CONCLUSIONS: In this highland site in western Kenya @entity311 transmission was low, but highly heterogeneous. To accurately characterize the true extent of @entity311 transmission, more sensitive and complementary metrics such as PCR or serology are required in addition to the standard microscopy and/or RDTs that are routinely used. This is likely to be the case in other low endemicity settings.

Use of different transmission metrics to describe XXXX epidemiology in the highlands of western Kenya.

@entity1 :: ('9606', 'Species') :: ['children'] @entity311 :: ('MESH:D008288', 'Disease') :: ['malaria'] @entity281 :: ('MESH:D007239', 'Disease') :: ['infection', 'malaria infection'] @entity1062 :: ('MESH:D013736', 'Disease') :: ['RDT', 'rapid diagnostic test']
@entity311 :: (MESH:D008288,Disease) :: ['malaria']
