title: Malaria hotspot areas in a highland Kenya site are consistent in epidemic and non-epidemic years and are associated with ecological factors.
abstract: BACKGROUND
  Malaria epidemics in highland areas of East Africa have caused considerable morbidity and mortality in the past two decades. Knowledge of "hotspot" areas of high malaria incidence would allow for focused preventive interventions in resource-poor areas, particularly if the hotspot areas can be discerned during non-epidemic periods and predicted by ecological factors.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: University of Michigan School of Public Health, Ann Arbor, Michigan, USA. kacey.ernst@gmail.com
authors.forename: Kacey C
authors.initials: KC
authors.lastname: Ernst
authors.forename: Samson O
authors.initials: SO
authors.lastname: Adoka
authors.forename: Dickens O
authors.initials: DO
authors.lastname: Kowuor
authors.forename: Mark L
authors.initials: ML
authors.lastname: Wilson
authors.forename: Chandy C
authors.initials: CC
authors.lastname: John
mesh_terms: D000531:Altitude; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D017753:Ecosystem; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008288:Malaria / Q000453:epidemiology*; D015999:Multivariate Analysis; D016017:Odds Ratio; D012307:Risk Factors