Abstract
Malaria remains a major public health problem in the Peruvian Amazon where the persistence of high-risk transmission areas (hotspots) challenges the current malaria control strategies. This study aimed at identifying significant space-time clusters of malaria incidence in Loreto region 2002–2013 and to determine significant changes across years in relation to the control measures applied. Poisson regression and purely temporal, spatial, and space-time analyses were conducted. Three significantly different periods in terms of annual incidence rates (AIR) were identified, overlapping respectively with the pre-, during, and post- implementation control activities supported by PAMAFRO project. The most likely space-time clusters of malaria incidence for P. vivax and P. falciparum corresponded to the pre- and first two years of the PAMAFRO project and were situated in the northern districts of Loreto, while secondary clusters were identified in eastern and southern districts with the latest onset and the shortest duration of PAMAFRO interventions. Malaria in Loreto was highly heterogeneous at geographical level and over time. Importantly, the excellent achievements obtained during 5 years of intensified control efforts totally vanished in only 2 to 3 years after the end of the program, calling for sustained political and financial commitment for the success of malaria elimination as ultimate goal.
Highlights
In 2014, the Peruvian Ministry of Health (MoH) recorded 65,239 malaria cases for the whole country, the majority of which were due to Plasmodium vivax (84%) and from the Amazon Region of Loreto (~90%)[1]
Between 2002 and 2013, a total of 424,176 confirmed malaria cases were reported in Loreto Region (Fig. 1), including 334,713 (79%) P. vivax and 89,463 (21%) P. falciparum cases
The secondary space-time cluster was located in Soplin district from January 2005 to December 2010 where the P. falciparum incidence was almost 30-fold higher (Ajd.IRR = 28.8) (Table 3). This 12-year retrospective analysis of the routinely collected malaria cases in Loreto Department allowed an in-depth characterization of significant space-time clusters of both P. vivax and P. falciparum malaria incidence in relation to applied control interventions
Summary
In 2014, the Peruvian Ministry of Health (MoH) recorded 65,239 malaria cases for the whole country, the majority of which were due to Plasmodium vivax (84%) and from the Amazon Region of Loreto (~90%)[1]. Afterwards, malaria incidence remained at low levels until the early 90’s, before increasing steadily until 1997 when Loreto experienced the most important malaria epidemic with a total of 158,115 reported cases, 34% of which were caused by P. falciparum. The annual incidence dropped markedly and remained between 45,000 and 55,000 cases from 2000 to 2005 It was followed by a steady decrease until 2010 and 2011 when only 11,504 and 11,793 cases were reported, respectively, following the scale-up of comprehensive control activities supported by the Global Fund Malaria Project “PAMAFRO”5. This study aimed at analysing trends in malaria incidence in Loreto between 2002 and 2013, and identifying significant space-time district-clusters of malaria incidence in relation to applied control efforts
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