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. Malaria continues to inflict a great health and socioeconomic burden on humanity, with an estimated 3.2 billion people at risk of being infected 1. In 2018, globally there were 228 million cases and 405,000 deaths, around 67% (272,000) of deaths were in children aged under 5 years 2. However, in 2018, there were 23 million fewer cases as compared to 2010 2. In 2016, malaria remained endemic in 91 countries and territories as compared to 108 in 2000 3. The World Health Organization (WHO) African Region accounts for around 90% of malaria cases globally, followed by the SouthEast 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, socioeconomic improvement in endemic countries and increasing urbanization 5-8. In 2018, total investment for malaria control and elimination was US$ 2.7 billion 2. WHO developed the Global Technical Strategy for Malaria 2016-2030 (GTS) 5 with an aim to fast track progress towards malaria elimination. This strategy is complemented by the Roll Back Malaria advocacy plan, Action and Investment to Defeat Malaria 2016-2030 (AIM) 9. GTS and AIM set a global goal to eliminate malaria in at least 21 countries by 2020, known as E-2020 countries and 35 countries by 2030 3,9. Malaria is reported from seven districts of Bhutan along the southern border with India. These districts are Chukha, Dagana, Pemagatshel, Samdrup Jongkhar, Samtse, Sarpang and Zhemgang (Fig. 1). Malaria control activities in Bhutan are based on: (1) Early diagnosis and prompt treatment wi...
Agent-based modelling is a useful approach for capturing heterogeneity in disease transmission. In this study, a synthetic population was developed for American Samoa using an iterative approach based on population census, questionnaire survey and land use data. The population will be used as the basis for a new agent-based model, intended specifically to fill the knowledge gaps about lymphatic filariasis transmission and elimination, but also to be readily adaptable to model other infectious diseases. The synthetic population was characterized by the statistically realistic population and household structure, and high-resolution geographic locations of households. The population was simulated over 40 years from 2010 to 2050. The simulated population was compared to estimates and projections of the U.S. Census Bureau. The results showed the total population would continuously decrease due to the observed large number of emigrants. Population ageing was observed, which was consistent with the latest two population censuses and the Bureau’s projections. The sex ratios by age groups were analysed and indicated an increase in the proportion of males in age groups 0–14 and 15–64. The household size followed a Gaussian distribution with an average size of around 5.0 throughout the simulation, slightly less than the initial average size 5.6.
Population mobility has been demonstrated to contribute to the persistent transmission and global diffusion of epidemics. In the Pacific Islands, population mobility is particularly important for emerging infectious diseases, disease elimination programs, and diseases spread by close contact. The extent of population mobility between American Samoa villages, Samoa districts and other countries was investigated based on travel data collected during community surveys in American Samoa in 2010 and 2014. Within American Samoa, workers commuted daily across the whole of the main island of Tutuila, with work hubs drawing from villages across the island. Of the 670 adult workers surveyed, 37% had traveled overseas in the past year, with 68% of trips to Samoa. Of children aged 8–13 years (n = 337), 57% had traveled overseas, with 55% of trips to Samoa. An extensive network of connections between American Samoa villages and Samoa districts was demonstrated, with most trips lasting one week to one month. Our study showed that populations in the Samoan islands are highly mobile, and quantified the extent and destinations of their travels. Our findings offer insight into the impact of population mobility on the transmission of infectious diseases and data to refine existing models of disease transmission in the Pacific islands.
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