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Malaria hotspot areas in a highland Kenya site are consistent in epidemic and non-epidemic years and are associated with ecological factors

DOI: 10.1186/1475-2875-5-78

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Abstract:

To address this issue, spatial distribution of malaria incidence and the relationship of ecological factors to malaria incidence were assessed in the highland area of Kipsamoite, Kenya, from 2001–2004.Clustering of disease in a single geographic "hotspot" area occurred in epidemic and non-epidemic years, with a 2.6 to 3.2-fold increased risk of malaria inside the hotspot, as compared to outside the area (P < 0.001, all 4 years). Altitude and proximity to the forest were independently associated with increased malaria risk in all years, including epidemic and non-epidemic years.In this highland area, areas of high malaria risk are consistent in epidemic and non-epidemic years and are associated with specific ecological risk factors. Ongoing interventions in areas of ecological risk factors could be a cost-effective method of significantly reducing malaria incidence and blunting or preventing epidemics, even in the absence of malaria early warning systems. Further studies should be conducted to see if these findings hold true in varied highland settings.It has been estimated that 34 million individuals in highland areas of East Africa are at risk for malaria [1] and malaria in these highland areas has been responsible for numerous deaths [2]. However, the levels of variation in malaria risk within these highland areas are not well described and only a few studies have investigated risk factors for malaria there [3-5]. Previous studies have demonstrated that malaria cases aggregate from the household to the countrywide level [3,6,7]. The determinants of such clustering are likely due to shared anthropogenic and environmental variables, as well as factors related to contagion such as population density and human interactions [8,9]. Brooker et al demonstrated that there was spatial clustering of malaria cases in children during an epidemic in a single year in highland area of Kenya [3]. However, without data from multiple years, it is difficult to discern if clusters of

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