Background Located in West Africa, Cabo Verde is an archipelago consisting of nine inhabited islands. Malaria has been endemic since the settlement of the islands during the sixteenth century and is poised to achieve malaria elimination in January 2021. The aim of this research is to characterize the trends in malaria cases from 2010 to 2019 in Cabo Verde as the country transitions from endemic transmission to elimination and prevention of reintroduction phases. Methods All confirmed malaria cases reported to the Ministry of Health between 2010 and 2019 were extracted from the passive malaria surveillance system. Individual-level data available included age, gender, municipality of residence, and the self-reported countries visited if travelled within the past 30 days, therby classified as imported. Trends in reported cases were visualized and multivariable logistic regression used to assess risk factors associated with a malaria case being imported and differences over time. Results A total of 814 incident malaria cases were reported in the country between 2010 and 2019, the majority of which were Plasmodium falciparum. Overall, prior to 2017, when the epidemic occurred, 58.1% (95% CI 53.6–64.6) of infections were classified as imported, whereas during the post-epidemic period, 93.3% (95% CI 86.9–99.7) were imported. The last locally acquired case was reported in January 2018. Imported malaria cases were more likely to be 25–40 years old (AOR: 15.1, 95% CI 5.9–39.2) compared to those under 15 years of age and more likely during the post-epidemic period (AOR: 56.1; 95% CI 13.9–225.5) and most likely to be reported on Sao Vicente Island (AOR = 4256.9, 95% CI = 260–6.9e+4) compared to Boavista. Conclusions Cabo Verde has made substantial gains in reducing malaria burden in the country over the past decade and are poised to achieve elimination in 2021. However, the high mobility between the islands and continental Africa, where malaria is still highly endemic, means there is a constant risk of malaria reintroduction. Characterization of imported cases provides useful insight for programme and enables better evidence-based decision-making to ensure malaria elimination can be sustained.

Cabo Verde reported the first case of COVID-19 on March 19, 2020. Containment measures were quickly implemented and over 80,000 COVID-19 tests were performed in 2020 with 11,840 confirmed infections (2% of the population) and 154 deaths. In a setting where the last locally acquired malaria case was reported in January 2018, any interruptions to malaria care-seeking have the potential for infections to go untreated and transmission re-establishing. This work aims to determine whether there was any change in the number of people seeking care or being tested for malaria and, using an interrupted time series analysis, identify if any change was associated with implemented COVID-19 measures. Routinely collected surveillance data for outpatient visits, testing for malaria and COVID-19 were aggregated by month for each health facility (outpatient and malaria) or by municipality (COVID-19) from 2017 through 2020. The timeline of COVID-19 measures was generated based on when and where they were implemented. Results show that there was a marked shift in care-seeking in Cabo Verde. Overall, the mean number of observed outpatient visits decreased from 2,057 visits per month during 2017-2019 to 1,088 in 2020, an estimated 28% reduction. However, malaria testing rates per 1,000 outpatient visits after the pandemic began increased by 8% compared to expected trends. Results suggest that the pandemic impacted care-seeking but led to a non-significant increase in testing for malaria per 1,000 outpatient visits. With the cessation of international travel, the risk of imported infections seeding new transmission declined suggesting the risk of undetected transmission was low. It is important for countries to understand their specific malaria risks and vulnerabilities in order to ensure that any progress towards the interruption of malaria transmission can be sustained.

Background: Located in West Africa, Cabo Verde is an archipelago consisting of nine inhabited islands. Malaria has been endemic since the settlement of the islands during the 16th century and is poised to achieve malaria elimination in January 2021. The aim of this research is to characterise the trends in malaria cases from 2010 to 2019 in Cabo Verde as the country transitions from endemic transmission to elimination and prevention of reintroduction phases.Methods: All confirmed malaria cases reported to the Ministry of Health between 2010 and 2019 were extracted from the passive malaria surveillance system. Individual-level data available included age, sex, municipality of residence, and the self-reported countries visited if travelled within the past 30 days, therby classified as imported. Trends in reported cases were visualised and multivariable logistic regression used to assess risk factors associated with a malaria case being imported and differences over time.Results: A total of 814 incident malaria cases were reported in the country between 2010 and 2019, the majority of which were Plasmodium falciparum. Overall, prior to 2017, when the epidemic occurred, 58.1% (95% CI: 53.6-64.6) of infections were classified as imported, whereas during the post-epidemic period, 93.3% (95% CI: 86.9-99.7) were imported. The last locally acquired case was reported in January 2018. Imported malaria cases were more likely to be 25-40 years old (AOR: 15.1, 95% CI: 5.9-39.2) compared to those under 15 years of age and more likely during the post-epidemic period (AOR: 56.1; 95% CI: 13.9-225.5) and most likely to be reported on São Vicente Island (AOR=4256.9, 95% CI=260-6.9e+4) compared to Boavista.Conclusions: Cabo Verde has made substantial gains in reducing malaria burden in the country over the past decade and are poised to achieve elimination in 2021. However, the high mobility between the islands and continental Africa, where malaria is still highly endemic, means there is a constant risk of malaria reintroduction. Characterisation of imported cases provides useful insight for program and enables better evidence-based decision-making to ensure malaria elimination can be sustained.

Background: Located in West Africa, Cabo Verde is an archipelago consisting of nine inhabited islands. Malaria has been endemic since the settlement of the islands during the 16th century and is poised to achieve malaria elimination in January 2021. The aim of this research is to characterise the trends in malaria cases from 2010 to 2019 in Cabo Verde as the country transitions from endemic transmission to elimination and prevention of reintroduction phases. Methods: All confirmed malaria cases reported to the Ministry of Health between 2010 and 2019 were extracted from the passive malaria surveillance system. Individual-level data available included age, sex, municipality of residence, and the self-reported countries visited if travelled within the past 30 days, therby classified as imported. Trends in reported cases were visualised and multivariable logistic regression used to assess risk factors associated with a malaria case being imported and differences over time.Results: A total of 814 incident malaria cases were reported in the country between 2010 and 2019, the majority of which were Plasmodium falciparum. Overall, prior to 2017, when the epidemic occurred, 58.08% (95% CI: 53.56-64.59) of infections were classified as imported, whereas during the post-epidemic period, 93.33% (95% CI: 86.97-99.70) were imported. The last locally acquired case was reported in January 2018. Imported malaria cases were more likely to be 25-40 years old (AOR: 15.14, 95% CI: 5.86-39.15) compared to those under 15 years of age and more likely during the post-epidemic period (AOR: 56.12; 95% CI: 13.97-225.49) and most likely to be reported on Sao Vicente Island (AOR=4256.9, 95% CI=260-6.96e+4) compared to Boa Vista. Conclusions: Cabo Verde has made substantial gains in reducing malaria burden in the country over the past decade and are poised to achieve elimination in 2021. However, the high mobility between the islands and continental Africa, where malaria is still highly endemic, means there is a constant risk of malaria reintroduction. Characterisation of imported cases provides useful insight for program and enables better evidence-based decision-making to ensure malaria elimination can be sustained.

Background Cabo Verde is one of the E-2020 Initiative, a group of 21 countries identified by World Health Organization (WHO) in 2016 as having the potential to eliminate malaria by 2020. Located in west Africa, Cabo Verde is an archipelago consisting of nine inhabited islands. Malaria has been endemic since the settlement of the islands during the during the 16th century and is poised to achieve malaria elimination in January 2021. The aim of this research is to characterise the trends in malaria cases from 2010 to 2019 as the country transitions from endemic transmission to elimination and prevention of reintroduction phases. Methods All confirmed malaria cases reported to the Ministry of Health between 2010 and 2019 were extracted and secondary analysis was conducted. Variables collected as part of the routine reporting for each confirmed case included age, sex, municipality of residence, and if classified as imported, the reported country of travel within the past 30 days, providing the presumed origin of infection. Trends in reported cases were visualised and logistic regression used to identify risk factors associated with imported malaria. Results A total of 819 malaria cases were reported in the country between 2010 and 2019, the majority of which were Plasmodium falciparum. Overall, 554 (67.6%) and 263 (32.1%) of cases were reported as locally acquired and imported, respectively, with the last locally acquired case reported in January 2018. Only two (0.20%) of the cases were classified as introduced, a single case in each of 2018 and 2019. Of the locally acquired cases, 80.5% (446/554) were reported during the outbreak in 2017. The majority of malaria cases were identified in males (766; 73.3%) or those aged 20 years or older (658; 79.7%). The adjusted odds ratio (AOR) of cases being imported was 3.73 (95% CI: 2.47–4.99) in the post epidemic period compared with the pre-epidemic period and reported on Sao Vicente island (AOR = 6.96, 95% CI = 4.40–9.53, p < 0.0001) compared to Boa Vista. Conclusions Cabo Verde has made substantial gains in reducing malaria burden in the country over the past decade and are poised to achieve elimination in 2020. However, the high mobility between the islands and continental Africa where malaria is still highly endemic, means there is a constant risk of malaria reintroduction. Characterisation of imported cases provides useful insight for program and enables better evidence-based decision-making to ensure malaria elimination can be sustained.