Spatial and temporal dynamics of malaria in Madagascar

Hanitriniaina Felana Angella Ihantamalala (1, 2) , Feno Jacob Rakotoarimanana (1) , Tanjona Ramiadantsoa (3) , Jean Marius Rakotondramanga (1) , Gwenaëlle Pennober (2) , Fanjasoa Rakotomanana (1) , Simon Cauchemez (4, 5) , Charlotte J E Metcalf (6) , Vincent Herbreteau (2, 7) , Amy Wesolowski (8)

1 IPM - Unité d'Epidémiologie [Antananarivo, Madagascar]
2 UMR 228 Espace-Dev, Espace pour le développement
3 University of Wisconsin-Madison
4 Modélisation mathématique des maladies infectieuses
5 C3BI - Centre de Bioinformatique, Biostatistique et Biologie Intégrative
6 Princeton University
7 IRD - Institut de Recherche pour le Développement
8 Johns Hopkins Bloomberg School of Public Health [Baltimore]

Background: Malaria is one of the primary health concerns in Madagascar. Based on the duration and intensity of transmission, Madagascar is divided into five epidemiological strata that range from low to mesoendemic transmission. In this study, the spatial and temporal dynamics of malaria within each epidemiological zone were studied. Methods: The number of reported cases of uncomplicated malaria from 112 health districts between 2010 and 2014 were compiled and analysed. First, a Standardized Incidence Ratio was calculated to detect districts with anomalous incidence compared to the stratum-level incidence. Building on this, spatial and temporal malaria clusters were identified throughout the country and their variability across zones and over time was analysed. Results: The incidence of malaria increased from 2010 to 2014 within each stratum. A basic analysis showed that districts with more than 50 cases per 1000 inhabitants are mainly located in two strata: East and West. Lower incidence values were found in the Highlands and Fringe zones. The standardization method revealed that the number of districts with a higher than expected numbers of cases increased through time and expanded into the Highlands and Fringe zones. The cluster analysis showed that for the endemic coastal region, clusters of districts migrated southward and the incidence of malaria was the highest between January and July with some variation within strata. Conclusion: This study identified critical districts with low incidence that shifted to high incidence and district that were consistent clusters across each year. The current study provided a detailed description of changes in malaria epidemiology and can aid the national malaria programme to reduce and prevent the expansion of the disease by targeting the appropriate areas.

Mots clés: SaTScan; Malaria; Standardized Incidence Ratio; Strata; Madagascar

Domaines: Santé publique et épidémiologie

Hanitriniaina Felana Angella Ihantamalala, Feno Jacob Rakotoarimanana, Tanjona Ramiadantsoa, Jean Marius Rakotondramanga, Gwenaëlle Pennober, et al.. Spatial and temporal dynamics of malaria in Madagascar. Malaria Journal, 2018, 17 (1), pp.58. ⟨10.1186/s12936-018-2206-8⟩. ⟨pasteur-01922282⟩