Abstract
BackgroundMalaria is one of the primary health concerns in Madagascar. Based on the duration and intensity of transmission, Madagascar is divided into five epidemiological strata that range from low to mesoendemic transmission. In this study, the spatial and temporal dynamics of malaria within each epidemiological zone were studied.MethodsThe number of reported cases of uncomplicated malaria from 112 health districts between 2010 and 2014 were compiled and analysed. First, a Standardized Incidence Ratio was calculated to detect districts with anomalous incidence compared to the stratum-level incidence. Building on this, spatial and temporal malaria clusters were identified throughout the country and their variability across zones and over time was analysed.ResultsThe incidence of malaria increased from 2010 to 2014 within each stratum. A basic analysis showed that districts with more than 50 cases per 1000 inhabitants are mainly located in two strata: East and West. Lower incidence values were found in the Highlands and Fringe zones. The standardization method revealed that the number of districts with a higher than expected numbers of cases increased through time and expanded into the Highlands and Fringe zones. The cluster analysis showed that for the endemic coastal region, clusters of districts migrated southward and the incidence of malaria was the highest between January and July with some variation within strata.ConclusionThis study identified critical districts with low incidence that shifted to high incidence and district that were consistent clusters across each year. The current study provided a detailed description of changes in malaria epidemiology and can aid the national malaria programme to reduce and prevent the expansion of the disease by targeting the appropriate areas.
Highlights
Malaria is one of the primary health concerns in Madagascar
Since 2007, the country has relied on a network of community health workers in 375 communes across the country to assist in the management of uncomplicated malaria [10,11,12].”
This study investigated how these clusters have changed over time highlighting the changing nature of malaria epidemiology that may help refine the target area for malaria control and potential outbreaks
Summary
Malaria is one of the primary health concerns in Madagascar. Based on the duration and intensity of transmission, Madagascar is divided into five epidemiological strata that range from low to mesoendemic transmission. Malaria remains a key global health concern and leading cause of mortality and morbidity worldwide. Global control efforts have resulted in a large reduction in the morbidity of the disease down from 13% in 2005 to 9% in 2015 [1] Despite this progress, there are still an estimated 214 million cases and 438,000 deaths in 2015, primarily in sub-Saharan Africa [2]. Ihantamalala et al Malar J (2018) 17:58 since 2008 Coverage of these interventions varies across the country, for example IPTP is primarily provided in endemic areas. LLINs are available throughout the country with three large distribution campaigns performed between 2009 and 2015 with coverage estimated at 82% in endemic areas and 38% in low transmission areas [9]. Since 2007, the country has relied on a network of community health workers in 375 communes across the country to assist in the management of uncomplicated malaria [10,11,12].”
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