Background Cross-border malaria is a major barrier to elimination efforts. Along the Venezuela-Brazil-Guyana border, intense human mobility fueled primarily by a humanitarian crisis and illegal gold mining activities has increased the occurrence of cross-border cases in Brazil. Roraima, a Brazilian state situated between Venezuela and Guyana, bears the greatest burden. This study analyses the current cross-border malaria epidemiology in Northern Brazil between the years 2007 and 2018. Methods De-identified data on reported malaria cases in Brazil were obtained from the Malaria Epidemiological Surveillance Information System for the years 2007 to 2018. Pearson’s Chi-Square test of differences was utilized to assess differences between characteristics of cross-border cases originating from Venezuela and Guyana, and between border and transnational cases. A logistic regression model was used to predict imported status of cases. Results Cross-border cases from Venezuela and Guyana made up the majority of border and transnational cases since 2012, and Roraima remained the largest receiving state for cross-border cases over this period. There were significant differences in the profiles of border and transnational cases originating from Venezuela and Guyana, including type of movement and nationality of patients. Logistic regression results demonstrated Venezuelan and Guyanese nationals, Brazilian miners, males, and individuals of working age had heightened odds of being an imported case. Furthermore, Venezuelan citizens had heightened odds of seeking care in municipalities adjacent Venezuela, rather than transnational municipalities. Conclusions Cross-border malaria contributes to the malaria burden at the Venezuela-Guyana-Brazil border. The identification of distinct profiles of case importation provides evidence on the need to strengthen surveillance at border areas, and to deploy tailored strategies that recognize different mobility routes, such as the movement of refuge-seeking individuals and of Brazilians working in mining.

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Background Deforestation and land use change is widespread in Madagascar, altering local ecosystems and creating opportunities for disease vectors, such as the Anopheles mosquito, to proliferate and more easily reach vulnerable, rural populations. Knowledge of risk factors associated with malaria infections is growing globally, but these associations remain understudied across Madagascar’s diverse ecosystems experiencing rapid environmental change. This study aims to uncover socioeconomic, demographic, and ecological risk factors for malaria infection across regions through analysis of a large, cross-sectional dataset. Methods The objectives were to assess (1) the ecological correlates of malaria vector breeding through larval surveys, and (2) the socioeconomic, demographic, and ecological risk factors for malaria infection in four ecologically distinct regions of rural Madagascar. Risk factors were determined using multilevel models for the four regions included in the study. Results The presence of aquatic agriculture (both within and surrounding communities) is the strongest predictive factor of habitats containing Anopheles larvae across all regions. Ecological and socioeconomic risk factors for malaria infection vary dramatically across study regions and range in their complexity. Conclusions Risk factors for malaria transmission differ dramatically across regions of Madagascar. These results may help stratifying current malaria control efforts in Madagascar beyond the scope of existing interventions.

The mobility of malaria-infected individuals poses challenges to elimination campaigns by way of spreading parasite drug resistance, straining country-to-country collaboration, and making routine data collection difficult, especially in resource-poor settings. Nevertheless, no concerted effort has been made to develop a common framework to define the spatial and temporal components of an imported malaria case and recommend the minimum data needed to identify it. We conducted a scoping review of imported malaria literature from 2010 to 2020 which showed that definitions vary widely, and local capabilities of detecting importation are often restricted in low-income countries. Following this, we propose a common definition for imported malaria and the minimum data required to identify a case, depending on the country’s capability of conducting an epidemiological investigation. Lastly, we utilize the proposed definition using data from Brazil to demonstrate both the feasibility and the importance of tracking imported cases. The case of Brazil highlights the capabilities of regular surveillance systems to monitor importation, but also the need to regularly use these data for informing local responses. Supporting countries to use regularly collected data and adopt a common definition is paramount to tackling the importation of malaria cases and achieving elimination goals set forth by the World Health Organization.

BackgroundDeforestation and land use change is widespread in Madagascar, altering local ecosystems and creating opportunities for disease vectors, such as the Anopheles mosquito, to proliferate and more easily reach vulnerable, rural populations. Knowledge of risk factors associated with malaria infections is growing globally, but these associations remain understudied across Madagascar’s diverse ecosystems experiencing rapid environmental change. This study aims to uncover socioeconomic, demographic, and ecological risk factors for malaria infection across regions through analysis of a large, cross-sectional dataset.MethodsHere, we assess (1) the ecological correlates of malaria vector breeding through larval surveys, and (2) the socioeconomic, demographic, and ecological risk factors for malaria infection in four ecologically distinct regions of rural Madagascar. We determine risk factors using multilevel models for the four regions included in the study.ResultsThe presence of aquatic agriculture (both within and surrounding communities) is the strongest predictive factor of habitats containing Anopheles larvae across all regions. We determine that ecological and socioeconomic risk factors for malaria infection vary dramatically across study regions and range in their complexity.ConclusionsRisk factors for malaria transmission differ dramatically across regions of Madagascar. These results may help stratifying current malaria control efforts in Madagascar beyond the scope of existing interventions.

Rubber surfacing is often used in playgrounds due to its potential injury prevention benefits and as a way to recycle waste tires. Available research on chemicals in recycled rubber has focused on synthetic turf applications, but is limited for playground rubber surfacing. Potential lead contamination from vulcanizing agents used in rubber surfacing are a possible concern; however this has not been researched. We examined levels of lead in poured-in-place rubber and compared them to levels in soil, sand, and wood mulch materials from 28 randomly selected playgrounds in Boston, MA, USA using X-ray fluorescence. To evaluate the association between material type and lead concentrations, we conducted a two-way ANOVA with repeated measures and built a linear regression model controlling for distance to major roadway, neighborhood-level status as an environmental justice area, peeling paint on the playground, and rubber condition. Average lead levels were 65.7 μg/g for soil, 22.0 μg/g for rubber, 8.5 μg/g for sand, and 9.0 μg/g for mulch. Our finding of lower concentrations of lead in sand and mulch compared to rubber and soil should be used to inform playground design to optimize children’s health, alongside other chemical and safety considerations.

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