Substantial development assistance has been directed towards reducing the high malaria burden in Malawi
over the past decade. We assessed changes in transmission over this period of malaria control scale-up by compiling
community Plasmodium falciparum rate (PfPR) data during 2000–2011 and used model-based geostatistical methods to
predict mean PfPR2–10 in 2000, 2005, and 2010. In addition, we calculated population-adjusted prevalences and
populations at risk by district to inform malaria control program priority setting. The national population-adjusted
PfPR2–10 was 37% in 2010, and we found no evidence of change over this period of scale-up. The entire population of
Malawi is under meso-endemic transmission risk, with those in districts along the shore of Lake Malawi and Shire River
Valley under highest risk. The lack of change in prevalence confirms modeling predictions that when compared with
lower transmission, prevalence reductions in high transmission settings require greater investment and longer time scales.