title: Spatio-temporal patterns of malaria infection in Bhutan: a country embarking on malaria elimination.
abstract: BACKGROUND
  At the verge of elimination of malaria in Bhutan, this study was carried out to analyse the trend of malaria in the endemic districts of Bhutan and to identify malaria clusters at the sub-districts. The findings would aid in implementing the control activities. Poisson regression was performed to study the trend of malaria incidences at district level from 1994 to 2008. Spatial Empirical Bayesian smoothing was deployed to identify clusters of malaria at the sub-district level from 2004 to 2008.
  
  
  RESULTS
  Trend of the overall districts and most of the endemic districts have decreased except Pemagatshel, which has an increase in the trend. Spatial cluster-outlier analysis showed that malaria clusters were mostly concentrated in the central and eastern Bhutan in three districts of Dagana, Samdrup Jongkhar and Sarpang. The disease clusters were reported throughout the year. Clusters extended to the non-transmission areas in the eastern Bhutan.
  
  
  CONCLUSIONS
  There is significant decrease in the trend of malaria with the elimination at the sight. The decrease in the trend can be attributed to the success of the control and preventive measures. In order to realize the target of elimination of malaria, the control measure needs to be prioritized in these high-risk clusters of malaria.
authors.affiliation: Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. dockinley@gmail.com
authors.forename: Kinley
authors.initials: K
authors.lastname: Wangdi
authors.forename: Jaranit
authors.initials: J
authors.lastname: Kaewkungwal
authors.forename: Pratap
authors.initials: P
authors.lastname: Singhasivanon
authors.forename: Tassanee
authors.initials: T
authors.lastname: Silawan
authors.forename: Saranath
authors.initials: S
authors.lastname: Lawpoolsri
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: White
mesh_terms: D000293:Adolescent; D000328:Adult; D001499:Bayes Theorem; D001631:Bhutan / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D019353:Endemic Diseases; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D016778:Malaria, Falciparum / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D016780:Malaria, Vivax / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D008297:Male; D008875:Middle Aged; D016012:Poisson Distribution; D012307:Risk Factors; D012621:Seasons