Abstract
BackgroundMalaria epidemics in highland areas of East Africa have caused considerable morbidity and mortality in the past two decades. Knowledge of "hotspot" areas of high malaria incidence would allow for focused preventive interventions in resource-poor areas, particularly if the hotspot areas can be discerned during non-epidemic periods and predicted by ecological factors.MethodsTo address this issue, spatial distribution of malaria incidence and the relationship of ecological factors to malaria incidence were assessed in the highland area of Kipsamoite, Kenya, from 2001–2004.ResultsClustering of disease in a single geographic "hotspot" area occurred in epidemic and non-epidemic years, with a 2.6 to 3.2-fold increased risk of malaria inside the hotspot, as compared to outside the area (P < 0.001, all 4 years). Altitude and proximity to the forest were independently associated with increased malaria risk in all years, including epidemic and non-epidemic years.ConclusionIn this highland area, areas of high malaria risk are consistent in epidemic and non-epidemic years and are associated with specific ecological risk factors. Ongoing interventions in areas of ecological risk factors could be a cost-effective method of significantly reducing malaria incidence and blunting or preventing epidemics, even in the absence of malaria early warning systems. Further studies should be conducted to see if these findings hold true in varied highland settings.
Highlights
Malaria epidemics in highland areas of East Africa have caused considerable morbidity and mortality in the past two decades
The present study addresses this gap in knowledge and demonstrates that in at least one highland area, there are persistent "hotspots" of increased malaria incidence and consistent ecological risk factors associated with increased risk
Research on malaria in the highlands of sub-Saharan Africa has focused on the development of early warning systems to identify when epidemics are expected
Summary
Malaria epidemics in highland areas of East Africa have caused considerable morbidity and mortality in the past two decades. The levels of variation in malaria risk within these highland areas are not well described and only a few studies have investigated risk factors for malaria there [3,4,5]. Malaria Journal 2006, 5:78 http://www.malariajournal.com/content/5/1/78 strated that malaria cases aggregate from the household to the countrywide level [3,6,7]. The determinants of such clustering are likely due to shared anthropogenic and environmental variables, as well as factors related to contagion such as population density and human interactions [8,9]. Identification of risk factors that lead to high case density could allow intervention programmes to be directed at areas high in risk factors, reducing the need for costly and extensive evaluations
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