Abstract
BackgroundOver the last decade, the incidence of confirmed malaria has declined significantly in Nepal. The aim of this paper is to assess the spatio-temporal distribution of malaria and its association with climatic factors and vector control interventions in two high-risk districts of Nepal.MethodsHotspot analysis was used to visualize the spatio-temporal variation of malaria incidence over the years at village level and generalized additive mixed models were fitted to assess the association of malaria incidence with climatic variables and vector control interventions.ResultsOpposing trends of malaria incidence were observed in two high-risk malaria districts of eastern and far-western Nepal after the introduction of long-lasting insecticidal nets (LLINs). The confirmed malaria incidence was reduced from 2.24 per 10,000 in 2007 to 0.31 per 10,000 population in 2011 in Morang district but increased from 3.38 to 8.29 per 10,000 population in Kailali district. Malaria hotspots persisted mostly in the same villages of Kailali district, whereas in Morang district malaria hotspots shifted to new villages after the introduction of LLINs. A 1° C increase in minimum and mean temperatures increased malaria incidence by 27% (RR =1.27, 95% CI =1.12-1.45) and 25% (RR =1.25, 95% CI =1.11-1.43), respectively. The reduction in malaria incidence was 25% per one unit increase of LLINs (RR =0.75, 95% CI =0.62-0.92). The incidence of malaria was 82% lower in Morang than in Kailali district (RR =0.18, 95% CI =0.11-0.33).ConclusionsThe study findings suggest that LLIN coverage should be scaled up to entire districts rather than high-incidence foci only. Climatic factors should be considered for malaria micro-stratification, mosquito repellents should be prescribed for those living in forests, forest fringe and foothills and have regular visits to forests, and imported cases should be controlled by establishing fever check posts at border crossings.Electronic supplementary materialThe online version of this article (doi:10.1186/1475-2875-13-457) contains supplementary material, which is available to authorized users.
Highlights
Over the last decade, the incidence of confirmed malaria has declined significantly in Nepal
Despite vector control interventions, significant malaria hotspots persisted in the same village development committee (VDC) over the years, mainly in Malakheti, Godwari and Sahajpur of Kailali district which are located in the western part of the district neighbouring Kanchanpur district (Figures 4 and 5)
Despite declining trends of malaria in Morang district, malaria hotspots have shifted to new VDCs, which in the past had been regarded as low-risk VDCs so that vector control interventions were not in place
Summary
The incidence of confirmed malaria has declined significantly in Nepal. Nepal has made significant progress in reducing the incidence of malaria by more than 84% over the last decade [1]. It has already achieved and exceeded the target of the Millennium Development Goals (MDGs) and universal coverage of malaria control interventions, and the Roll Back Malaria (RBM) targets of 2010 [1,2,3,4,5]. There are fewer districts classified as high- and moderate-risk (25 instead of 31) and the overall population living in VDCs at risk (estimated at 1,254 VDCs out of 3,972) is declining [2], which indicates the progress made to eliminate malaria-endemic VDCs (foci) and to achieve the malaria elimination goal by 2026
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