@article{dfc2f2a2e07a457ba5da2c41e61c7cc2,
title = "A spatio-temporal analysis to identify the drivers of malaria transmission in Bhutan",
abstract = "At a time when Bhutan is on the verge of malaria elimination, the aim of this study was to identify malaria clusters at high geographical resolution and to determine its association with local environmental characteristics. Malaria cases from 2006-2014 were obtained from the Vector-borne Disease Control Program under the Ministry of Health, Bhutan. A Zero-Inflated Poisson multivariable regression model with a conditional autoregressive (CAR) prior structure was developed. Bayesian Markov chain Monte Carlo (MCMC) simulation with Gibbs sampling was used to estimate posterior parameters. A total of 2,062 Plasmodium falciparum and 2,284 Plasmodium vivax cases were reported during the study period. Both species of malaria showed seasonal peaks with decreasing trend. Gender and age were not associated with the transmission of either species of malaria. P. falciparum increased by 0.7% (95% CrI: 0.3%, 0.9%) for a one mm increase in rainfall, while climatic variables (temperature and rainfall) were not associated with P. vivax. Insecticide treated bed net use and residual indoor insecticide coverage were unaccounted for in this study. Hot spots and clusters of both species were isolated in the central southern part of Bhutan bordering India. There was significant residual spatial clustering after accounting for climate and demographic variables.",
keywords = "Bhutan/epidemiology, Humans, Incidence, India/epidemiology, Insecticide-Treated Bednets, Malaria, Falciparum/epidemiology, Malaria, Vivax/epidemiology, Plasmodium falciparum/pathogenicity, Plasmodium vivax/pathogenicity, Spatio-Temporal Analysis",
author = "Kinley Wangdi and Zhijing Xu and Suwannatrai, {Apiporn T} and Johanna Kurscheid and Aparna Lal and Rinzin Namgay and Kathryn Glass and Gray, {Darren J} and Clements, {Archie C A}",
note = "Funding Information: Malaria continues to inflict a great health and socio-economic burden on humanity, with an estimated 3.2 billion people at risk of being infected1. In 2018, globally there were 228 million cases and 405,000 deaths, around 67% (272,000) of deaths were in children aged under 5 years2. However, in 2018, there were 23 million fewer cases as compared to 20102. In 2016, malaria remained endemic in 91 countries and territories as compared to 108 in 20003. The World Health Organization (WHO) African Region accounts for around 90% of malaria cases globally, followed by the South-East Asian Region (SEAR) (5%) and the Eastern Mediterranean Region (2%)4. Some of the factors that have led to the observed reductions in malaria incidence since 2000, are intensification of malaria control interventions supported by unprecedented financial support, socio-economic improvement in endemic countries and increasing urbanization5–8. In 2018, total investment for malaria control and elimination was US$ 2.7 billion2. Publisher Copyright: {\textcopyright} 2020, The Author(s).",
year = "2020",
month = dec,
day = "1",
doi = "10.1038/s41598-020-63896-7",
language = "English",
volume = "10",
pages = "1--10",
journal = "Scientific Reports",
issn = "2045-2322",
publisher = "Nature Publishing Group",
number = "1",
}
