Quantifying spatial heterogeneity of malaria in the endemic Papua region of Indonesia: Analysis of epidemiological surveillance data.

Autor:	Fadilah I; Oxford University Clinical Research Unit Indonesia, Jakarta, Indonesia., Djaafara BA; Oxford University Clinical Research Unit Indonesia, Jakarta, Indonesia.; MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom., Lestari KD; Oxford University Clinical Research Unit Indonesia, Jakarta, Indonesia., Fajariyani SB; Sub-Directorate for Malaria Control, Ministry of Health, Jakarta, Indonesia., Sunandar E; West Papua Provincial Health Office, Papua Barat, Indonesia., Makamur BG; West Papua Provincial Health Office, Papua Barat, Indonesia., Wopari B; Papua Provincial Health Office, Papua, Indonesia., Mabui S; Papua Provincial Health Office, Papua, Indonesia., Ekawati LL; Oxford University Clinical Research Unit Indonesia, Jakarta, Indonesia.; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom., Sagara R; Oxford University Clinical Research Unit Indonesia, Jakarta, Indonesia., Lina RN; Oxford University Clinical Research Unit Indonesia, Jakarta, Indonesia., Argana G; Sub-Directorate for Malaria Control, Ministry of Health, Jakarta, Indonesia., Ginting DE; Sub-Directorate for Malaria Control, Ministry of Health, Jakarta, Indonesia., Sumiwi ME; Directorate General of Public Health, Ministry of Health, Jakarta, Indonesia., Laihad FJ; UNICEF Indonesia Country Office, Jakarta, Indonesia., Mueller I; Division of Population Health and Immunity, Walter and Eliza Hall Institute, Melbourne, Australia., McVernon J; Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Australia., Baird JK; Oxford University Clinical Research Unit Indonesia, Jakarta, Indonesia.; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom., Surendra H; Oxford University Clinical Research Unit Indonesia, Jakarta, Indonesia., Elyazar IRF; Oxford University Clinical Research Unit Indonesia, Jakarta, Indonesia.
Jazyk:	angličtina
Zdroj:	The Lancet regional health. Southeast Asia [Lancet Reg Health Southeast Asia] 2022 Aug 05; Vol. 5, pp. 100051. Date of Electronic Publication: 2022 Aug 05 (Print Publication: 2022).
DOI:	10.1016/j.lansea.2022.100051
Abstrakt:	Background: As control efforts progress towards elimination, malaria is likely to become more spatially concentrated in few local areas. The purpose of this study was to quantify and characterise spatial heterogeneity in malaria transmission-intensity across highly endemic Indonesian Papua. Methods: We analysed individual-level malaria surveillance data for nearly half a million cases (2019-2020) reported in the Papua and West Papua provinces and adapted the Gini index approach to quantify spatial heterogeneity at the district and health-unit levels. In this context, high Gini index implies disproportionately distributed malaria cases across the region. We showed malaria incidence trends and the spatial and temporal distribution of sociodemographic characteristics and aetiological parasites among cases. Findings: While Papua province accounted for the majority of malaria cases reported in the region and had seen a rise in transmission since 2015, West Papua province had maintained a comparatively low incidence. We observed that Gini index estimates were high, particularly when the lower spatial scale of health units was evaluated. The Gini index appears to be inversely associated to annual parasite-incidence, as well as the proportions of vivax malaria, male sex, and adults. Interpretation: This study suggests that areas with varying levels of transmission-intensities exhibited distinct characteristics. Malaria was distributed in a markedly disproportionate manner throughout the region, emphasising the need for spatially targeted interventions. Periodic quantification and characterisation of risk heterogeneity at various spatial levels using routine malaria surveillance data may aid in tracking progress towards elimination and guiding evidence-informed prioritisation of resource allocation. Funding: The study was funded by the Australian Government Department of Foreign Affairs and Trade Indo-Pacific Centre for Health Security through the Strengthening Preparedness in the Asia-Pacific Region through Knowledge (SPARK) project. Competing Interests: All authors declare no competing interests. (© 2022 The Author(s).)
Databáze:	MEDLINE
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