Abstract
Border regions have been implicated as important hot spots of malaria transmission, particularly in Latin America, where free movement rights mean that residents can cross borders using just a national ID. Additionally, rural livelihoods largely depend on short-term migrants traveling across borders via the Amazon’s river networks to work in extractive industries, such as logging. As a result, there is likely considerable spillover across country borders, particularly along the border between Peru and Ecuador. This border region exhibits a steep gradient of transmission intensity, with Peru having a much higher incidence of malaria than Ecuador. In this paper, we integrate 13 years of weekly malaria surveillance data collected at the district level in Peru and the canton level in Ecuador, and leverage hierarchical Bayesian spatiotemporal regression models to identify the degree to which malaria transmission in Ecuador is influenced by transmission in Peru. We find that increased case incidence in Peruvian districts that border the Ecuadorian Amazon is associated with increased incidence in Ecuador. Our results highlight the importance of coordinated malaria control across borders.
Highlights
Malaria remains a major health threat globally, with 228 million cases leading to 405,000 deaths worldwide in 2018 [1]
To assess the degree to which malaria transmission was driven by connectivity to the river networks connecting the Ecuadorian Amazon to the Peruvian Amazon, we considered two
P. falciparum malaria, remained at low levels across the Ecuadorian Amazon until January 2016, when incidence suddenly spiked to nearly 4 cases/1000/week before falling back down to less than 1/2 cases/1000/week for the remainder of the study period
Summary
Malaria remains a major health threat globally, with 228 million cases leading to 405,000 deaths worldwide in 2018 [1]. While staggering, these numbers represent declines in transmission and mortality since 2010, when there were an estimated 251 million cases and 585,000 deaths [1]. (213 million) of the cases and 94% of the deaths reported in 2018 [1]. The incidence rate of Plasmodium falciparum, the parasite species contributing the greatest to mortality, is estimated to be around 500 cases per thousand people per year in sub-Saharan Africa, compared to the 250 cases per thousand people per year in the Americas and Central and South Asia combined; Int. J. Public Health 2020, 17, 7434; doi:10.3390/ijerph17207434 www.mdpi.com/journal/ijerph
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