Space-time variation of malaria incidence in Yunnan province, China.
BACKGROUND
Understanding spatio-temporal variation in malaria incidence provides a basis for effective disease control planning and monitoring.


METHODS
Monthly surveillance data between 1991 and 2006 for Plasmodium vivax and Plasmodium falciparum malaria across 128 counties were assembled for Yunnan, a province of China with one of the highest burdens of malaria. County-level Bayesian Poisson regression models of incidence were constructed, with effects for rainfall, maximum temperature and temporal trend. The model also allowed for spatial variation in county-level incidence and temporal trend, and dependence between incidence in June-September and the preceding January-February.


RESULTS
Models revealed strong associations between malaria incidence and both rainfall and maximum temperature. There was a significant association between incidence in June-September and the preceding January-February. Raw standardised morbidity ratios showed a high incidence in some counties bordering Myanmar, Laos and Vietnam, and counties in the Red River valley. Clusters of counties in south-western and northern Yunnan were identified that had high incidence not explained by climate. The overall trend in incidence decreased, but there was significant variation between counties.


CONCLUSIONS
Dependence between incidence in summer and the preceding January-February suggests a role of intrinsic host-pathogen dynamics. Incidence during the summer peak might be predictable based on incidence in January-February, facilitating malaria control planning, scaled months in advance to the magnitude of the summer malaria burden. Heterogeneities in county-level temporal trends suggest that reductions in the burden of malaria have been unevenly distributed throughout the province.
Clements
Archie C A
AC
University of Queensland, School of Population Health, Queensland, Australia. a.clements@uq.edu.au
Barnett
Adrian G
AG
Cheng
Zhang Wei
ZW
Snow
Robert W
RW
Zhou
Hom Ning
HN
D000818:Animals; D002681:China / Q000453:epidemiology; D005843:Geography; D006801:Humans; D015994:Incidence; D016778:Malaria, Falciparum / Q000453:epidemiology*; D016780:Malaria, Vivax / Q000453:epidemiology*; D011891:Rain; D012621:Seasons; D013997:Time Factors; D014887:Weather