title: Distance to Anopheles sundaicus larval habitats dominant among risk factors for parasitemia in meso-endemic Southwest Sumba, Indonesia.
abstract: BACKGROUND
  The decline in intensity of malaria transmission in many areas now emphasizes greater importance of understanding the epidemiology of low to moderate transmission settings. Marked heterogeneity in infection risk within these populations creates opportunities to understand transmission and guide resource allocation to greater impact.
  
  
  METHODS
  In this study, we examined spatial patterns of malaria transmission in a hypo- to meso-endemic area of eastern Indonesia using malaria prevalence data collected from a cross-sectional socio-demographic and parasitological survey conducted from August to November 2010. An entomological survey performed in parallel, identified, mapped, and monitored local anopheline larval habitats.
  
  
  RESULTS
  A single spatial cluster of higher malaria prevalence was detected during the study period (relative risk=2.13; log likelihood ratio=20.7; P<0.001). In hierarchical multivariate regression models, risk of parasitemia was inversely correlated with distance to five Anopheles sundaicus known larval habitats [odds ratio (OR)=0.21; 95% confidence interval (CI)=0.14-0.32; P<0.001], which were located in a geographically restricted band adjacent to the coastline. Increasing distance from these sites predicted increased hemoglobin level across age strata after adjusting for confounders (OR=1.6; 95% CI=1.30-1.98; P<0.001).
  
  
  CONCLUSIONS
  Significant clustering of malaria parasitemia in close proximity to very specific and relatively few An. sundaicus larval habitats has direct implications for local control strategy, policy, and practice. These findings suggest that larval source management could achieve profound if not complete impact in this region.
authors.forename: Christian P
authors.initials: CP
authors.lastname: Nixon
authors.forename: Christina E
authors.initials: CE
authors.lastname: Nixon
authors.forename: Dian Sidik
authors.initials: DS
authors.lastname: Arsyad
authors.forename: Krisin
authors.initials: K
authors.lastname: Chand
authors.forename: Frilasita A
authors.initials: FA
authors.lastname: Yudhaputri
authors.forename: Wajiyo
authors.initials: W
authors.lastname: Sumarto
authors.forename: Suradi
authors.initials: S
authors.lastname: Wangsamuda
authors.forename: Puji B
authors.initials: PB
authors.lastname: Asih
authors.forename: Sylvia S
authors.initials: SS
authors.lastname: Marantina
authors.forename: Isra
authors.initials: I
authors.lastname: Wahid
authors.forename: Gang
authors.initials: G
authors.lastname: Han
authors.forename: Jennifer F
authors.initials: JF
authors.lastname: Friedman
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bangs
authors.forename: Din
authors.initials: D
authors.lastname: Syafruddin
authors.forename: J Kevin
authors.initials: JK
authors.lastname: Baird
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D000852:Anopheles / Q000469:parasitology*; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D017753:Ecosystem; D005260:Female; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D007223:Infant; D007303:Insect Vectors / Q000469:parasitology*; D007814:Larva; D008288:Malaria / Q000453:epidemiology* / Q000469:parasitology / Q000635:transmission; D008297:Male; D018512:Parasitemia / Q000453:epidemiology / Q000469:parasitology; D010961:Plasmodium / Q000502:physiology*; D015995:Prevalence; D012044:Regression Analysis; D012307:Risk Factors; D062206:Spatial Analysis; D055815:Young Adult
keywords: Anopheles sundaicus,; Larval habitats,; Malaria risk factors,; Spatial scan statistic