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Whereas data on insecticide resistance and its underlying mechanisms exist for parts of Zambia, data remain limited in the southern part of the country. This study investigated the status of insecticide resistance, metabolic mechanisms, and parasite infection in Anopheles funestus along Lake Kariba in southern Zambia. Indoor-resting mosquitoes were collected from 20 randomly selected houses within clusters where a mass drug administration trial was conducted and raised to F1 progeny. Non-blood-fed 2- to 5-day-old female An. funestus were exposed to WHO insecticide-impregnated papers with 0.05% deltamethrin, 0.1% bendiocarb, 0.25% pirimiphos-methyl, or 4% dichloro-diphenyl-trichloroethane (DDT). In separate assays, An. funestus were pre-exposed to piperonyl butoxide (PBO) to determine the presence of monooxygenases. Wild-caught An. funestus that had laid eggs for susceptibility assays were screened for circumsporozoite protein of Plasmodium falciparum by ELISA, and sibling species were identified by polymerase chain reaction. Anopheles funestus showed resistance to deltamethrin and bendiocarb but remained susceptible to pirimiphos-methyl and DDT. The pre-exposure of An. funestus to PBO restored full susceptibility to deltamethrin but not to bendiocarb. The overall sporozoite infection rate in An. funestus populations was 5.8%. Detection of pyrethroid and carbamate resistance in An. funestus calls for increased insecticide resistance monitoring to guide planning and selection of effective insecticide resistance management strategies. To prevent the development of resistance and reduce the underlying vectorial capacity of mosquitoes in areas targeted for malaria elimination, an effective integrated vector management strategy is needed.

Over the past decade, Zambia has made substantial progress against malaria and has recently set the ambitious goal of eliminating by 2021. In the context of very high vector control and improved access to malaria diagnosis and treatment in Southern Province, we implemented a community-randomized controlled trial to assess the impact of four rounds of community-wide mass drug administration (MDA) and household-level MDA (focal MDA) with dihydroartemisinin–piperaquine (DHAP) implemented between December 2014 and February 2016. The mass treatment campaigns achieved relatively good household coverage (63–79%), were widely accepted by the community (ranging from 87% to 94%), and achieved very high adherence to the DHAP regimen (81–96%). Significant declines in all malaria study end points were observed, irrespective of the exposure group, with the overall parasite prevalence during the peak transmission season declining by 87.2% from 31.3% at baseline to 4.0% in 2016 at the end of the trial. Children in areas of lower transmission (< 10% prevalence at baseline) that received four MDA rounds had a 72% (95% CI = 12–91%) reduction in malaria parasite prevalence as compared with those with the standard of care without any mass treatment. Mass drug administration consistently had the largest short-term effect size across study end points in areas of lower transmission following the first two MDA rounds. In the context of achieving very high vector control coverage and improved access to diagnosis and treatment for malaria, our results suggest that MDA should be considered for implementation in African settings for rapidly reducing malaria outcomes in lower transmission settings.

From 2014 to 2016, a community-randomized controlled trial in Southern Province, Zambia, compared mass drug administration (MDA) and focal MDA (fMDA) with the standard of care. Acceptability of the intervention was assessed quantitatively using closed-ended and Likert scale–based questions posed during three household surveys conducted from April to May in 2014, 2015, and 2016 in 40 health catchments that implemented MDA and fMDA and 20 catchments that served as trial controls. In 2014 and 2015, 47 households per catchment were selected, targeting 1,880 households in MDA and fMDA trial arms; in 2016, 55 households per catchment were selected for a target of 2,200 households in MDA and fMDA trial arms. Concurrently, 27 focus group discussions and 23 in-depth interviews with 248 participants were conducted on reasons for testing and treatment refusal, reasons for nonadherence, and community perception of the MDA campaign. Results demonstrated that the MDA campaign was highly accepted with more than 99% of respondents stating that they would take treatment if positive for malaria. High acceptability at baseline could be associated with test-and-treat campaigns recently conducted in the study area. There was a large increase in the acceptability of prophylactic treatment if negative for malaria from the baseline to follow-up survey for adults and children, from 62% to 96% for each. This likely resulted from an intensive community-wide sensitization program that occurred before the first treatment round at each household during community health worker visits.

Whereas data on insecticide resistance and its underlying mechanisms exist for parts of Zambia, data remain limited in the southern part of the country. This study investigated the status of insecticide resistance, metabolic mechanisms, and parasite infection in Anopheles funestus along Lake Kariba in southern Zambia. Indoor-resting mosquitoes were collected from 20 randomly selected houses within clusters where a mass drug administration trial was conducted and raised to F1 progeny. Non–blood-fed 2- to 5-day-old female An. funestus were exposed to WHO insecticide-impregnated papers with 0.05% deltamethrin, 0.1% bendiocarb, 0.25% pirimiphos-methyl, or 4% dichloro-diphenyl-trichloroethane (DDT). In separate assays, An. funestus were pre-exposed to piperonyl butoxide (PBO) to determine the presence of monooxygenases. Wild-caught An. funestus that had laid eggs for susceptibility assays were screened for circumsporozoite protein of Plasmodium falciparum by ELISA, and sibling species were identified by polymerase chain reaction. Anopheles funestus showed resistance to deltamethrin and bendiocarb but remained susceptible to pirimiphos-methyl and DDT. The pre-exposure of An. funestus to PBO restored full susceptibility to deltamethrin but not to bendiocarb. The overall sporozoite infection rate in An. funestus populations was 5.8%. Detection of pyrethroid and carbamate resistance in An. funestus calls for increased insecticide resistance monitoring to guide planning and selection of effective insecticide resistance management strategies. To prevent the development of resistance and reduce the underlying vectorial capacity of mosquitoes in areas targeted for malaria elimination, an effective integrated vector management strategy is needed.

To evaluate current practices and standards of evaluation and treatment of childhood febrile illness in Southern Province, Zambia.From November to December 2013, we conducted a cross-sectional survey of facilities and health workers and we observed the health workers' interactions with febrile children and their caregivers. The facility survey recorded level of staffing, health services provided by the facility, availability and adequacy of medical equipment, availability of basic drugs and supplies and availability of treatment charts and guidelines. The health worker survey assessed respondents' training, length of service, access to national guidelines and job aids for managing illnesses, and their practice and knowledge on management of neonatal and child illnesses. We also conducted exit interviews with caregivers to collect information on demographic characteristics, chief complaints, counselling and drug dispensing practices.This study included 24 health facilities, 53 health workers and 161 children presenting with fever. Facilities were insufficiently staffed, stocked and equipped to adequately manage childhood fever. Children most commonly presented with upper respiratory tract infections (46%; 69), diarrhoea (31%; 27) and malaria (10%; 16). Health workers insufficiently evaluated children for danger signs, and less than half (47%; 9/19) of children with pneumonia received appropriate antibiotic treatment. Only 57% (92/161) were tested for malaria using either rapid diagnostic tests or microscopy.Various health system challenges resulted in a substantial proportion of children receiving insufficient management and treatment of febrile illness. Interventions are needed including strengthening the availability of commodities and improving diagnosis and treatment of febrile illness.Évaluer les pratiques et les normes actuelles d'évaluation et de traitement des maladies fébriles infantiles dans la Province méridionale de la Zambie.De novembre à décembre 2013, nous avons mené une enquête transversale auprès d‘établissements et de professionnels de santé et nous avons observé les interactions entre les professionnels de santé, les enfants fiévreux et leurs proches. L'enquête réalisée dans les établissements s'est intéressée à la dotation en personnel, aux services sanitaires dispensés par l'établissement, à la disponibilité et à la convenance des équipements médicaux, à la disponibilité de médicaments et de fournitures élémentaires et à la présence de directives et de feuilles d'observation. L'enquête réalisée auprès des professionnels de santé a analysé la formation des répondants, leur nombre d'années de service, leur accès aux directives nationales et aux aide-mémoires pour la prise en charge des maladies, ainsi que leur pratique et leurs connaissances en matière de prise en charge des maladies infantiles et néonatales. Nous avons également interrogé les proches à leur sortie afin de recueillir des informations sur les caractéristiques démographiques, les principales plaintes, les conseils et les pratiques d'administration des médicaments.Cette étude a examiné 24 établissements de santé, 53 professionnels de santé et 161 enfants atteints de fièvre. Les établissements manquaient de personnel, de produits en stock et d'équipements pour prendre en charge correctement les cas de fièvre infantile. Les enfants étaient le plus souvent atteints d'infections des voies respiratoires supérieures (46%; 69), de diarrhée (31%; 27) et de paludisme (10%; 16). Les professionnels de santé n'évaluaient pas suffisamment les signes de danger chez les enfants, et moins de la moitié (47%; 9/19) des enfants atteints de pneumonie ont reçu un traitement antibiotique adapté. Seuls 57% (92/161) ont fait l'objet d'un dépistage du paludisme, au moyen de tests de diagnostic rapide ou par microscopie.À cause des différents problèmes du système sanitaire, une part importante d'enfants ne bénéficie pas d'une prise en charge et d'un traitement suffisants des maladies fébriles. Des interventions sont nécessaires, notamment pour augmenter la disponibilité des produits et améliorer le diagnostic et le traitement des maladies fébriles.Evaluar las prácticas y los estándares de evaluación y tratamiento actuales de las enfermedades febriles en los niños en la Provincia del Sur, Zambia.De noviembre a diciembre de 2013, se realizó una encuesta transversal de centros y trabajadores sanitarios y se observaron las interacciones de los trabajadores sanitarios con niños con fiebre y sus cuidadores. La encuesta de los centros registró el nivel de personal y servicios de salud ofrecidos en el centro, la disponibilidad e idoneidad de los equipos médicos, la disponibilidad de medicamentos y suministros básicos y la disponibilidad de cronogramas y directrices de tratamiento. La encuesta a los trabajadores sanitarios evaluó la formación de los encuestados, la duración del servicio, el acceso a directrices nacionales y ayudas laborales para la gestión de enfermedades y su práctica y conocimiento acerca de la gestión de las enfermedades neonatales e infantiles. También se realizaron entrevistas de salida con cuidadores para recopilar información acerca de las características demográficas, los motivos de consulta, asesoramiento y prácticas de distribución de medicamentos.Este estudio abarcó 24 centros sanitarios, 53 trabajadores sanitarios y 161 niños con fiebre. Los centros no contaban con personal, suministros y equipos suficientes para gestionar de forma adecuada la fiebre en niños. Las afecciones más comunes presentadas por los niños eran infecciones del tracto respiratorio superior (46%; 69), diarrea (31%; 27) y malaria (10%; 16). Los trabajadores sanitarios evaluaron a los niños de forma insuficiente en busca de signos de peligro, y menos de la mitad (47%; 9/19) de los niños con neumonía recibieron el tratamiento antibiótico adecuado. Solo el 57% (92/161) fue sometido a pruebas de malaria utilizando pruebas de diagnóstico rápido o microscópicas.Varios desafíos del sistema sanitario llevan a un gran porcentaje de niños que reciben una gestión y tratamiento insuficientes de las enfermedades febriles. Es necesario intervenir para fortalecer la disponibilidad de productos básicos y mejorar el diagnóstico y el tratamiento de las enfermedades febriles.تقييم الممارسات الحالية ومعايير التقييم ومعالجة مرض الحمى لدى الأطفال في المنطقة الجنوبية في زامبيا.في الفترة ما بين نوفمبر/تشرين الثاني إلى ديسمبر/كانون الأول 2013، قمنا بإجراء استقصاء مقطعي للمرافق الصحية والعاملين بمجال الصحة ولاحظنا تفاعلات العاملين بمجال الصحة مع الحمى لدى الأطفال ومقدمي الرعاية لهم. وكان المسح الذي تم على مرافق الرعاية الصحية قد سجّل مستوى التوظيف، والخدمات الصحية المقدمة من قبل المِرفق، وتوافر المعدات الطبية ومدى كفاءتها، ومدى توافر المستلزمات والأدوية الأساسية، وتوافر الجداول التوضيحية وإرشادات العلاج. كما عمل المسح الذي تم على العاملين في مجال الصحة على تقييم التدريب الذي خضع له المشاركون، ومدة الخدمة، وإمكانية الاطلاع على الإرشادات القومية والأدوات المساعدة على العمل للسيطرة على المرض، والإجراءات المتبعة من جانبهم، ومعرفتهم بإدارة أمراض الأطفال وحديثي الولادة. كما قمنا أيضًا بإجراء مقابلات نهائية مع مقدمي الرعاية لجمع المعلومات المتعلقة بالخصائص الديموغرافية، والشكاوى الأساسية، والاستشارة والإجراءات المتبعة لصرف الدواء.تضمنت هذه الدراسة 24 مرفقًا صحيًا، و53 عاملاً في مجال الصحة، و161 طفلاً معرضًا للحمى. وُجد أن المرافق لم يتوفر بها ما يكفي من الموظفين، وغير مؤهلة ولا مجهزة لإدارة الحمى لدى الأطفال بشكلٍ ملائم. أغلب الأطفال كانوا مصابين بالتهاب الجهاز التنفسي العلوي (‏46‏%، 69)، والإسهال (31‏%، 27)، والملاريا (10‏%، 16). ولم يقم العاملون في مجال الصحة بتقييم الأطفال للكشف عن الأعراض الخطيرة بشكلٍ كافِ، وكان أقل من نصف الأطفال (47‏%، 9/19) المصابين بالالتهاب الرئوي قد تلقوا علاجًا مناسبًا بالمضادات الحيوية. ولم يتم فحص إلا 57‏% (92/161) للكشف عن الإصابة بالملاريا باستخدام إما الاختبارات التشخيصية السريعة أو الاختبارات المجهرية.تؤدي التحديات المختلفة التي يتعرض لها النظام الصحي إلى وجود نسبة كبيرة من الأطفال ممن يتلقون علاجًا وإدارة غير كافية لمرض الحمى. ويلزم إجراء التدخلات بما في ذلك ما كان منها لتعزيز توافر التجهيزات وتحسين تشخيص مرض الحمى وعلاجه.旨在评估赞比亚南部省当前的小儿热病评估和治疗实践和标准。.我们从 2013 年 11 月到 12 月对医疗机构和医务人员进行了横断面调查，并且观察了医务人员与发热儿童及其看护人之间的互动。 医疗机构调查记录了人员配备水平、医疗机构提供的卫生服务、医疗设备的可用性和充足性、基本药物和用品的可用性以及治疗计划和指南的可用性。 医务人员调查评估了受访者的培训、服务时长、获取全国疾病管理指南和工作支持的机会，以及他们在新生儿和小儿疾病管理方面的实践和知识。 我们也对看护人进行了离职访问，以收集有关人口统计特征、主诉、咨询和配药实践的信息。.本次调查涵盖 24 家医疗机构，53 名医务人员和 161 名出现发热症状的儿童。 这些医疗机构存在人员、医疗用品和设备配备不足的情况，无法对儿童发热进行良好的管理。 儿童最常见的症状是上呼吸道感染 (46%; 69)、腹泻 (31%; 27) 和疟疾 (10%; 16)。 医务人员无法充分评估儿童的危险症状，只有不到一半 (47%; 9/19) 的肺炎儿童接受了适当的抗生素治疗。 只有 57% (92/161) 的儿童通过快速诊断测试或显微镜检查接受了疟疾检测。.卫生系统面临的多种挑战导致大部分儿童无法接受足够的热病管理和治疗。 需要在提高商品可用性、改善热病诊断和治疗等方面加强干预。.Оценить текущую практику и стандарты оценки и лечения детских заболеваний, сопровождающихся лихорадкой, в Южной провинции, Замбия.С ноября по декабрь 2013 года мы провели одномоментное обследование медицинских учреждений и медицинских работников, наблюдая за тем, как медицинские работники взаимодействуют с детьми, страдающими лихорадкой, и с лицами, осуществляющими за ними уход. В В ходе обследования медицинских учреждений фиксировался уровень укомплектованности кадрами и медицинских услуг, предоставляемых этими учреждениями, наличие и соответствие медицинского оборудования, наличие основных лекарств и расходных материалов, а также наличие руководств по лечению. В ходе обследования медицинских работников была проведена оценка их подготовки, стажа работы, доступа к национальным руководствам и инструкциям по лечению заболеваний, а также их практики и знаний относительно лечения болезней новорожденных и детей. Мы также провели беседы с лицами, ухаживающими за больными, для сбора информации о демографических характеристиках, основных жалобах, консультировании и практике выдачи лекарств.Это исследование включало 24 медицинских учреждения, 53 медицинских работника и 161 ребенка с лихорадкой. Учреждения были недостаточно укомплектованы персоналом и имели недостаточное оснащение и снабжение для осуществления надлежащего лечения лихорадки у детей. У детей чаще всего встречались инфекции верхних дыхательных путей (46%, 69), диарея (31%, 27) и малярия (10%, 16). Медицинские работники проводили недостаточное обследование детей на наличие опасных симптомов, и менее половины детей с пневмонией (47%, 9 из 19) получали соответствующее лечение антибиотиками. Только 57% (92 из 161) были протестированы на малярию с использованием либо экспресс-диагностических тестов, либо микроскопии.Различные проблемы системы здравоохранения приводят к тому, что значительная часть детей получает недостаточное лечение заболеваний, сопровождающихся лихорадкой. Необходимо принять меры, включая повышение доступности лекарств и оборудования, а также улучшение диагностики и лечения заболеваний, сопровождающихся лихорадкой.

Background Malaria elimination efforts can be undermined by imported malaria infections. Imported infections are classified based on travel history. Methods A genetic strategy was applied to better understand the contribution of imported infections and to test for local transmission in the very low prevalence region of Richard Toll, Senegal. Results Genetic relatedness analysis, based upon molecular barcode genotyping data derived from diagnostic material, provided evidence for both imported infections and ongoing local transmission in Richard Toll. Evidence for imported malaria included finding that a large proportion of Richard Toll parasites were genetically related to parasites from Thiès, Senegal, a region of moderate transmission with extensive available genotyping data. Evidence for ongoing local transmission included finding parasites of identical genotype that persisted across multiple transmission seasons as well as enrichment of highly related infections within the households of non-travellers compared to travellers. Conclusions These data indicate that, while a large number of infections may have been imported, there remains ongoing local malaria transmission in Richard Toll. These proof-of-concept findings underscore the value of genetic data to identify parasite relatedness and patterns of transmission to inform optimal intervention selection and placement.

A full century after the Mexican Revolution of 1910 and 18 years after the 1994 Zapatista uprising, Mexico, our southern neighbor, is in the throes of another crisis, gripped by an epoch of unprecedented drug-related violence and war which is bleeding in and out of its borders, both south and north. This report provides an update on continuing Zapatista autonomy, placing the narrative into the context of the impact of the narco wars on Mexican agricultural communities.

Book reviewed in this article: Massacres in the Jungle; Ixcan, Guatemala 1975–1982. Ricardo Falla.

Something has been happening in the indigenous communities of Chiapas. From the remote jungles of the Lacandona Forest, word has been issued that reiterates Zapatista solidarity with indigenous struggles. This essay reports on the goings-on leading up to the Red Alert by the Zapatistas in the summer of 2005. The authors find resistance and resiliency on the milpas of Chiapas where small farmers and ejido members join the growing chorus of those saying “no” to state and international development plans. The resistance is inspired by an understanding that these “development” plans (including the building of a dam) will flood homesteads, lead to privatization, and ultimately displace the people of Chiapas from their ancestral land and way of life. The authors offer ethnographic vignettes that give voice to the concerns and activities of both rural campesinos and urban vendors of San Cristobal.

We bring together all the knowledge, then we will be united and embrace each other and demonstrate that our culture is one of the largest cultures that ever existed… It is important that the voice of the native people is heard. (Tlakaelel, a 78 year old spiritual elder from Mexico, discussing Hueco Tanks, in March 1999)

All anthropological research, including student projects, involves dilemmas concerning informed consent and the oversight of institutional review boards. In Chiapas, the leadership of an autonomous municipality has designed their own process of research approval. During the intensive schedule of teaching a field program and assisting students to develop field studies, the authors learned how those with whom they work in the field structure their approval process, through meetings and consensus. In this ethnographic narrative, the authors examine the details of this negotiation, linking it to the process of seeking autonomy through development in Chiapas, where “informed permission” and committed collaboration add symmetry to the research endeavor.

Background: Given progress in malaria control in recent years, many control programmes in sub-Saharan Africa will soon be required to strengthen systems for surveillance in order to further drive transmission to zero. Yet few practical experiences are available to guide control programmes in designing surveillance system components in low transmission, pre-elimination, and elimination phases. Methods: A malaria case investigation programme was piloted for 12 weeks in 2012 in Richard Toll district of northern Senegal. Malaria infections (N = 110) were identified through facility-based passive case detection and investigated within three days. Rapid diagnostic tests (RDT) and a brief questionnaire were administered to 5,520 individuals living within the index case compound or within five neighbouring compounds. Results: In comparison with family and neighbours, index cases were more likely to be male, age 15–49, and to report travel within the past 15 days that entailed an overnight stay. Twenty-three (0.4%) of family/neighbours were RDT-positive. Potential risk factors for infection among family and neighbours were examined, including: sex, age, occupation, travel history, bed net usage, and residence (index vs neighbouring compound). Adjusting for all factors, relative risk (RR) of infection was associated with residence in the index case household (RR = 3.18, p < 0.05) and recent travel, including travel to Dakar (RR = 19.93, p < 0.001), travel within the region (RR = 9.57, p < 0.01), and to other regions in Senegal (RR = 94.30, p < 0.001). Recent fever among RDT-positive family/neighbours was uncommon (30%). Modifications to testing criteria were examined to optimize the efficiency of secondary case investigations in this population. Limiting blood testing to residents of the index case compound and neighbours with recent travel or fever would have identified 20/23 (87%) of the infections through testing 1,173 individuals. Information on the remaining three infections suggests that additional screening for boarding school attendees may facilitate identification of all cases. Conclusions: The primary risk factor for malaria infection in the low transmission district of Richard Toll is travel. Additional intervention and monitoring strategies to target travellers at risk of malaria infection are needed in this region. Optimizing case investigation with specific targeted testing and treatment of at-risk family and neighbours strengthens the systems needed for continued progress towards malaria elimination in northern Senegal.

Background Relatively few programmes have attempted to actively engage the private sector in national malaria control efforts. This paper evaluates the health impact of a large-scale distribution of insecticide-treated nets (ITNs) conducted in partnership with a Zambian agribusiness, and its cost-effectiveness from the perspective of the National Malaria Control Programme (NMCP). Methods The study was designed as a cluster-randomized controlled trial. A list of 81,597 cotton farmers was obtained from Dunavant, a contract farming company in Zambia’s cotton sector, in December 2010. 39,963 (49%) were randomly selected to obtain one ITN each. Follow-up interviews were conducted with 438 farmers in the treatment and 458 farmers in the control group in June and July 2011. Treatment and control households were compared with respect to bed net ownership, bed net usage, self-reported fever, and self-reported confirmed malaria. Cost data was collected throughout the programme. Results The distribution effectively reached target beneficiaries, with approximately 95% of households in the treatment group reporting that they had received an ITN through the programme. The average increase in the fraction of household members sleeping under an ITN the night prior to the interview was 14.6 percentage points (p-value

The last twenty years of anthropology have been ones of doubt and epistemic crisis. We have generally shrunk away from grand theories to explore the specific in all sorts of experimental and diverse ways. But the crisis of representation did not seem to cross over into the appropriation of terms and concepts that became icons of discourse representing other places and their peoples. This is true of the metaphor of the Border, which has served a number of intellectual, political and cultural purposes, none of them particularly helpful to the Border region itself. In this case, Border is not meant metaphorically, but is a very real, and greatly imagined place, the edge of the nation-state.

God and Production in a Guatemalan Town. SHELDON ANNIS. Refugees of a Hidden War: The Aftermath of Counterinsurgency in Guatemala. BEATRIZ MANZ.

Background In areas with ongoing malaria transmission, strategies to clear parasites from populations can reduce infection and transmission. The objective of this paper was to describe a malaria mass testing and treatment (MTAT) intervention implemented in six kebeles (villages) in Amhara Region, Ethiopia, at the beginning of the 2014 transmission season. Methods Intervention kebeles were selected based on incidence of passively detected Plasmodium falciparum and mixed (P. falciparum and P. vivax) malaria cases during the 2013 malaria transmission season. All households in intervention kebeles were targeted; consenting residents received a rapid diagnostic test (RDT) and RDT-positive individuals received artemether-lumefantrine for P. falciparum/mixed infections or chloroquine for P. vivax. Data were collected on MTAT participation, sociodemographic characteristics, malaria risk factors, and RDT positivity. Results Of 9162 households targeted, 7974 (87.0 %) participated in the MTAT. Among the 35,389 residents of these households, 30,712 (86.8 %) received an RDT. RDT-positivity was 1.4 % (0.3 % P. vivax, 0.7 % P. falciparum, 0.3 % mixed), ranging from 0.3 to 5.1 % by kebele; 39.4 % of RDT-positive individuals were febrile, 28.5 % resided in the same household with another RDT-positive individual, 23.0 % were not protected by vector control interventions [mosquito net or indoor residual spray (IRS)], and 7.1 % had travel history. For individuals under 10 years of age, the odds of being RDT-positive was significantly higher for those with fever, recent use of anti-malarial drugs or residing in the same household with another RDT-positive individual; 59.0 % of RDT-positive individuals had at least one of these risk factors. For individuals 10 years of age and older, the odds of being RDT positive was significantly higher for those with reported travel, fever, recent use of anti-malarial drugs, no use of vector control, and those residing in the same household as another RDT-positive individual; 71.2 % of RDT-positive individuals had at least one of these risk factors. Conclusions In the Ethiopia setting, an MTAT intervention is operationally feasible and can be conducted with high coverage. RDT-positivity is low and varies widely by kebele. While several risk factors are significantly associated with RDT-positivity, there are still many RDT-positive individuals who do not have any of these risk factors. Strategies that target populations for testing and treatment based on these risk factors alone are likely to leave many infections undetected. Electronic supplementary material The online version of this article (doi:10.1186/s12936-016-1333-3) contains supplementary material, which is available to authorized users.