Spatial variation of malaria incidence in young children from a geographically homogeneous area with high endemicity.
BACKGROUND
In sub-Saharan Africa, malaria is a leading cause of morbidity and mortality among young children. Detailed knowledge of spatial variation of malaria epidemiology and associated risk factors is important for planning and evaluating malaria-control measures.


METHODS
The spatial variation of malaria incidences and socioeconomic factors were assessed over 21 months, from January 2003 to September 2005, in 535 children from 9 villages of a small rural area with high Plasmodium falciparum transmission in Ghana. Household positions were mapped by use of a global positioning system, and the spatial effects on malaria rates were assessed by means of ecological analyses and bivariate Poisson regression controlling for possible confounding factors.


RESULTS
Malaria incidence was surprisingly heterogeneous between villages, and ecological analyses showed strong correlations with village area (R(2) = 0.74; P = .003) and population size (R(2) = 0.68; P = .006). Malaria risk was affected by a number of socioeconomic factors. Poisson regression showed an independent linear rate reduction with increasing distance between children's households and the fringe of the forest.


CONCLUSIONS
The exact location of households in villages is an independent and important factor for the variation of malaria incidence in children from high-transmission areas. This fact should be considered in the planning of intervention trials and in spatial targeting of malaria interventions at a local level.
Kreuels
Benno
B
Infectious Disease Epidemiology Group, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
Kobbe
Robin
R
Adjei
Samuel
S
Kreuzberg
Christina
C
von Reden
Claudia
C
Bäter
Kathrin
K
Klug
Stefan
S
Busch
Wibke
W
Adjei
Ohene
O
May
Jürgen
J
D000818:Animals; D019353:Endemic Diseases; D005260:Female; D040362:Geographic Information Systems; D005869:Ghana / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D016778:Malaria, Falciparum / Q000453:epidemiology*; D008297:Male; D011446:Prospective Studies; D012424:Rural Population; D019371:Topography, Medical; D014197:Trees / Q000469:parasitology*