Abstract
BackgroundIn the process of geographical retraction of malaria, some important endemicity pockets remain. Here, we report results from a study developed to obtain detailed community data from an important malaria hotspot in Latin America (Alto Juruá, Acre, Brazil), to investigate the association of malaria with socioeconomic, demographic and living conditions.MethodsA household survey was conducted in 40 localities (n = 520) of Mâncio Lima and Rodrigues Alves municipalities, Acre state. Information on previous malaria, schooling, age, gender, income, occupation, household structure, habits and behaviors related to malaria exposure was collected. Multiple correspondence analysis (MCA) was applied to characterize similarities between households and identify gradients. The association of these gradients with malaria was assessed using regression.ResultsThe first three dimensions of MCA accounted for almost 50% of the variability between households. The first dimension defined an urban/rurality gradient, where urbanization was associated with the presence of roads, basic services as garbage collection, water treatment, power grid energy, and less contact with the forest. There is a significant association between this axis and the probability of malaria at the household level, OR = 1.92 (1.23–3.02). The second dimension described a gradient from rural settlements in agricultural areas to those in forested areas. Access via dirt road or river, access to electricity power-grid services and aquaculture were important variables. Malaria was at lower risk at the forested area, OR = 0.55 (1.23–1.12). The third axis detected intraurban differences and did not correlate with malaria.ConclusionsLiving conditions in the study area are strongly geographically structured. Although malaria is found throughout all the landscapes, household traits can explain part of the variation found in the odds of having malaria. It is expected these results stimulate further discussions on modelling approaches targeting a more systemic and multi-level view of malaria dynamics.
Highlights
In the process of geographical retraction of malaria, some important endemicity pockets remain
Immigrants were attracted to the settlements created by the National Institute for Land Reform (INCRA) along new roads crossing the Amazonian region
About half (57.3%) of the Mâncio Lima population lives in the administrative center, the remainder distributed in 57 small localities scattered along dirt roads and rivers
Summary
In the process of geographical retraction of malaria, some important endemicity pockets remain. Within the Brazilian Amazon, three municipalities (Mâncio Lima, Rodrigues Alves and Cruzeiro do Sul) constitute a persistent malaria hotspot (defined as a site with significantly higher disease risk than average), for both P. falciparum and P. vivax parasites [10]. This area will be referred to as the “Juruá hotspot” in reference to the administrative region where it is located. Many studies have assessed large-scale drivers of malaria in the Amazon, and in the Juruá hotspot, associating malaria risk with forest cover [10], deforestation [11], and fish farming [12]. Malaria transmission in this area is found in both rural and urban zones, and the Juruá hotspot constitutes one of the seven sites for urban malaria studies of the International Centers of Excellence for Malaria Research (ICEMR) [13]
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