Abstract
Background Plasmodium vivax imposes substantial morbidity and mortality burdens in endemic zones. Detailed understanding of the contemporary spatial distribution of this parasite is needed to combat it. We used model based geostatistics (MBG) techniques to generate a contemporary map of risk of Plasmodium vivax malaria in Indonesia in 2010.Methods Plasmodium vivax Annual Parasite Incidence data (2006–2008) and temperature masks were used to map P. vivax transmission limits. A total of 4,658 community surveys of P. vivax parasite rate (PvPR) were identified (1985–2010) for mapping quantitative estimates of contemporary endemicity within those limits. After error-checking a total of 4,457 points were included into a national database of age-standardized 1–99 year old PvPR data. A Bayesian MBG procedure created a predicted PvPR1–99 endemicity surface with uncertainty estimates. Population at risk estimates were derived with reference to a 2010 human population surface.ResultsWe estimated 129.6 million people in Indonesia lived at risk of P. vivax transmission in 2010. Among these, 79.3% inhabited unstable transmission areas and 20.7% resided in stable transmission areas. In western Indonesia, the predicted P. vivax prevalence was uniformly low. Over 70% of the population at risk in this region lived on Java and Bali islands, where little malaria transmission occurs. High predicted prevalence areas were observed in the Lesser Sundas, Maluku and Papua. In general, prediction uncertainty was relatively low in the west and high in the east.ConclusionMost Indonesians living with endemic P. vivax experience relatively low risk of infection. However, blood surveys for this parasite are likely relatively insensitive and certainly do not detect the dormant liver stage reservoir of infection. The prospects for P. vivax elimination would be improved with deeper understanding of glucose-6-phosphate dehydrogenase deficiency (G6PDd) distribution, anti-relapse therapy practices and manageability of P. vivax importation risk, especially in Java and Bali.
Highlights
Plasmodium vivax malaria is the most widely distributed species of human malaria, threatening nearly 3 billion people in 95 countries ranging from temperate to tropical in the Americas, Africa, and Asia [1,2]
The completed database was checked via various levels of exclusion criteria in order to obtain the final input data set for modelling as follows: removing surveys located only to large (.100 km2) and small polygons (.25 km2), removing those surveys that could not be precisely geo-positioned and removing those that could not be temporally disaggregated into independent surveys or for which the survey date was unknown
We have estimated that 1.7 million km2 (89.8%) of a total land area of 1.9 million km2 were endemic for P. vivax malaria (Table 1)
Summary
Plasmodium vivax malaria is the most widely distributed species of human malaria, threatening nearly 3 billion people in 95 countries ranging from temperate to tropical in the Americas, Africa, and Asia [1,2]. Despite the reputation of P. vivax as a benign infection with very low risk of death, contemporary studies demonstrate substantial morbidity [4,5,6,7] and mortality [8,9,10,11] burdens in endemic zones. The distribution of risk of this infection emerges as a vital consideration in developing strategies that may mitigate this potentially serious threat. This may be especially true in places like the vast number of islands scattered. Plasmodium vivax imposes substantial morbidity and mortality burdens in endemic zones. We used model based geostatistics (MBG) techniques to generate a contemporary map of risk of Plasmodium vivax malaria in Indonesia in 2010
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