title: Remote sensing-based time series models for malaria early warning in the highlands of Ethiopia.
abstract: BACKGROUND
  Malaria is one of the leading public health problems in most of sub-Saharan Africa, particularly in Ethiopia. Almost all demographic groups are at risk of malaria because of seasonal and unstable transmission of the disease. Therefore, there is a need to develop malaria early-warning systems to enhance public health decision making for control and prevention of malaria epidemics. Data from orbiting earth-observing sensors can monitor environmental risk factors that trigger malaria epidemics. Remotely sensed environmental indicators were used to examine the influences of climatic and environmental variability on temporal patterns of malaria cases in the Amhara region of Ethiopia.
  
  
  METHODS
  In this study seasonal autoregressive integrated moving average (SARIMA) models were used to quantify the relationship between malaria cases and remotely sensed environmental variables, including rainfall, land-surface temperature (LST), vegetation indices (NDVI and EVI), and actual evapotranspiration (ETa) with lags ranging from one to three months. Predictions from the best model with environmental variables were compared to the actual observations from the last 12 months of the time series.
  
  
  RESULTS
  Malaria cases exhibited positive associations with LST at a lag of one month and positive associations with indicators of moisture (rainfall, EVI and ETa) at lags from one to three months. SARIMA models that included these environmental covariates had better fits and more accurate predictions, as evidenced by lower AIC and RMSE values, than models without environmental covariates.
  
  
  CONCLUSIONS
  Malaria risk indicators such as satellite-based rainfall estimates, LST, EVI, and ETa exhibited significant lagged associations with malaria cases in the Amhara region and improved model fit and prediction accuracy. These variables can be monitored frequently and extensively across large geographic areas using data from earth-observing sensors to support public health decisions.
authors.affiliation: Geographic Information Science Center of Excellence, South Dakota State University, Brookings, SD 57007, USA.
authors.forename: Alemayehu
authors.initials: A
authors.lastname: Midekisa
authors.forename: Gabriel
authors.initials: G
authors.lastname: Senay
authors.forename: Geoffrey M
authors.initials: GM
authors.lastname: Henebry
authors.forename: Paulos
authors.initials: P
authors.lastname: Semuniguse
authors.forename: Michael C
authors.initials: MC
authors.lastname: Wimberly
mesh_terms: D005002:Ethiopia / Q000453:epidemiology; D006801:Humans; D008288:Malaria / Q000453:epidemiology*; D063245:Plant Development; D011891:Rain; D058998:Remote Sensing Technology / Q000379:methods*; D018570:Risk Assessment; D013696:Temperature