Abstract
Background: In Cambodia, malaria persists with changing epidemiology and resistance to antimalarials. This study aimed to describe how malaria has evolved spatially from 2006 to 2019 in Cambodia. Methods: We undertook a secondary analysis of existing malaria data from all government healthcare facilities in Cambodia. The epidemiology of malaria was described by sex, age, seasonality, and species. Spatial clusters at the district level were identified with a Poisson model. Results: Overall, incidence decreased from 7.4 cases/1000 population in 2006 to 1.9 in 2019. The decrease has been drastic for females, from 6.7 to 0.6/1000. Adults aged 15–49 years had the highest malaria incidence among all age groups. The proportion of Plasmodium (P.) falciparum + Mixed among confirmed cases declined from 87.9% (n = 67,489) in 2006 to 16.6% (n = 5290) in 2019. Clusters of P. falciparum + Mixed and P. vivax + Mixed were detected in forested provinces along all national borders. Conclusions: There has been a noted decrease in P. falciparum cases in 2019, suggesting that an intensification plan should be maintained. A decline in P. vivax cases was also noted, although less pronounced. Interventions aimed at preventing new infections of P. vivax and relapses should be prioritized. All detected malaria cases should be captured by the national surveillance system to avoid misleading trends.
Highlights
Malaria, an Anopheles mosquito-borne disease, remains a serious public health issue globally, it is preventable and curable [1]
The Epidemiology Unit of the National Centre for Parasitology, Entomology and Malaria Control provided Health Management Information System (HMIS) malaria data for the cases recorded between 1 January 2006 and 31 December 2019
We investigated the existence of clusters [48,49] by testing two hypotheses: (1) H0 = malaria cases in each district throughout the country are proportional to the population, and (2) HA = malaria cases in one or more districts are statistically higher than expected proportional to the population
Summary
An Anopheles mosquito-borne disease, remains a serious public health issue globally, it is preventable and curable [1]. According to the World Health Organization (WHO), an estimated 228 million malaria cases occurred worldwide in 2018, compared with 251 million cases in 2010 and 231 million cases in 2017 [2]. Morbidity and mortality rates due to malaria vary from one global region to another. The overall malaria incidence rate was 57.4 per 1000 at-risk population, ranging from 2.6 per 1000 at-risk population in the WHO Western Pacific Region covering. 37 countries of Oceania, East Asia, and Southeast Asia to 229.3 per 1000 at-risk population in the WHO African Region covering 47 countries in Africa in 2018 [2,3,4]. The deaths due to malaria were lowest at 0.4 per 100,000 population in the WHO Region of the Americas and highest at 41.0 per 100,000 in the WHO Africa Region.
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