Background: As the incidence of malaria decreases the distribution of malaria becomesrnhighly heterogeneous and concentrated in certain geographical areas and households. Due tornthis the risk of being infected by malaria becomes highly variable within the same localityrnand households. Identifying the distribution patterns of malaria is crucial in the control asrnwell as elimination of malaria.rnMethods: A cross sectional survey was carried out targeting a total of 18 rapid diagnosticrntest(RDT)-confirmed malaria infected and 18 individuals that visited the health-post forrnmalaria unrelated cases between October and December 2016 including their immediate sixrnneighbors and family members. Consenting individuals were screened for malaria using RDTrnand dried blood spots were collected for quantification of parasites using species specific 18Srnbased quantitative polymerase chain reaction (qPCR). Spatial clustering of malaria infectionsrnwas assessed using SaTScan Software.rnResults: RDT-detected malaria (any species) was higher in the community around indexrncases compared to controls (P = 0.001). Asymptomatic qPCR-detected P. falciparumrninfections were higher in the community around index cases (13.9%) compared to controlsrn(9.5%; P = 0.038) while the distribution of qPCR-detected P. vivax was similar (P = 0.926).rnChildren had the highest burden of malaria and carry high density infections compared tornadults. SaTScan detected four geographically non-overlapping significant hotspot of anyrnmalaria cases with relative risk of 2.11, 1.9, 1.89 and 1.86. Individuals who lived inrnhouseholds (HHs) within at risk areas were more likely to have previous malaria episodesrn(33.1%, 177/233) compared to individuals in HHs outside risk areas (1.5%, 3/203; odds ratiorn[OR], 32.9; 95% CI, 10.2 â€“ 106.3). People in risk areas utilize malaria control interventionsrnbetter than people in HHs outside of risk areas and live in iron sheet houses with eavernopenings and better HH facilities. HHs within the clusters of higher malaria incidence wasrncloser to water bodies and farther from health posts. People who lived in HHs at risk areasrnwalk in the night, enter their houses late and leave their houses early than people who lived inrnrisk free areas.rnConclusion: The distribution of malaria was heterogeneous and clustered in the studyrndistrict. Symptomatic and asymptomatic malaria distributed significantly around index casesrncompared to non-malaria control cases. Malaria control and elimination strategies of therncountry might benefit by targeting hotspots of malaria by following patients. Hot spotrnpopulation carries the biggest burden of malaria and they might contribute disproportionatelyrnto the onward maintenance of malaria infections even outside of the risk areasrnrnKey words: Cluster, Asymptomatic, Heterogeneous,rnIX qPCR Sat Scan