Serological markers, combined with spatial analysis, offer a comparatively more sensitive means by which
to measure and detect foci of malaria transmission in highland areas than traditional malariometric indicators. Plasmodium
falciparum parasite prevalence, seroprevalence, and seroconversion rate to P. falciparum merozoite surface protein-119
(MSP-119) were measured in a cross-sectional survey to determine differences in transmission between altitudinal strata.
Clusters of P. falciparum parasite prevalence and high antibody responses to MSP-119 were detected and compared.
Results show that P. falciparum prevalence and seroprevalence generally decreased with increasing altitude. However,
transmission was heterogeneous with hotspots of prevalence and/or seroprevalence detected in both highland and highland
fringe altitudes, including a serological hotspot at 2,200 m. Results demonstrate that seroprevalence can be used
as an additional tool to identify hotspots of malaria transmission that might be difficult to detect using traditional crosssectional
parasite surveys or through vector studies. Our study findings identify ways in which malaria prevention and
control can be more effectively targeted in highland or low transmission areas via serological measures. These tools will
become increasingly important for countries with an elimination agenda and/or where malaria transmission is becoming
patchy and focal, but receptivity to malaria transmission remains high.