Locations of Plasmodium falciparum -positive cases sampled in the Republic of Djibouti (1998, 1999, 2002, and 2009) Sampling sites where Plasmodium falciparum cases were diagnosed with rapid diagnostic tests and confirmed by PCR. Forty-six blood samples were collected from September to December 1998 (red dot), 61 in April 1999 (blue dot), and 32 from March to May 2002 (light green dot) from symptomatic patients with P. falciparum who had not travelled outside the city of Djibouti during the preceding month and declared not to have taken any antimalarial drug before blood sampling. In 2009, 42 Djiboutian samples were collected from November 2008 to January 2009 by the Djiboutian Malaria Control Unit (Ministry of Health) (khaki green) . One blood sample was obtained from a Djiboutian military recruit who presented with clinical malaria (purple dot) in January 2009 and who stayed at the training camp in Debrezeit (Ethiopia) for 10 months prior to blood collection. Three blood samples provided by the Department of Parasitology and Vector Borne Diseases (Ethiopian Health and Nutrition Research Institute) were collected in Southeast Ethiopia (dark green dot) in 2008. According to the official census of Djiboutian population, Djibouti exhibits a high urbanization rate. Djibouti city, Ali Sabieh, Dikhil, Tadjourah, Arta, and Obock account for 62%, 11%, 10%, 9%, 5%, and 4% of the national population, respectively .