title: Spatial patterns and determinants of malaria infection during pregnancy in Zambia.
abstract: BACKGROUND
  Malaria in pregnancy (MiP) is a major concern in Zambia. Here we aim to determine the burden and risk factors of MiP.
  
  
  METHODS
  Monthly reported district-level malaria cases among pregnant women (count data) from January 2009 to December 2014 were obtained from the Zambian District Health Information System. Negative binomial regression model was used to investigate the associations between vector control tools, coverage of health care facilities, transportation networks and population density. Data on MiP treatment were obtained from the 2012 Zambian Malaria Indicator Survey. Yearly clusters of MiP were investigated using spatial statistics in ArcGIS v 10.1.
  
  
  RESULTS
  The results indicated that MiP decreased in Zambia between 2010 and 2013. MiP was observed throughout the year, but showed a strong seasonal pattern. Persistent hotspots of MiP were reported in the southeast and northeast regions of Zambia, with districts that had better access to rail road and presence of water bodies associated with decreased prevalence of MiP. Better indoor residual spraying and long-lasting insecticide-treated nets coverage was demonstrated to be protective against MiP.
  
  
  CONCLUSIONS
  Mapping the distribution of MiP to track the future requirements for scaling up essential disease-prevention efforts in stable hotspots can help the Zambian National Malaria Control Center to further develop strategies to reduce malaria prevalence in this vulnerable sub-population.
authors.affiliation: Ministry of Health, National Malaria Control Centre, Lusaka, Zambia.
authors.forename: Mulakwa
authors.initials: M
authors.lastname: Kamuliwo
authors.affiliation: Independent Consultant, Baltimore, MD, USA.
authors.forename: Karen E
authors.initials: KE
authors.lastname: Kirk
authors.affiliation: Vector Control Specialist/Consultant, 11 Granite Street, Plot 33421/917 Kamwa South, Lusaka, Zambia.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Chanda
authors.affiliation: Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA.
authors.forename: Maha A
authors.initials: MA
authors.lastname: Elbadry
authors.affiliation: Macha Research Trust, Macha, Zambia.
authors.forename: Jailos
authors.initials: J
authors.lastname: Lubinda
authors.affiliation: Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Weppelmann
authors.affiliation: Department of Public Health, Copperbelt University, School of Medicine, Ndola, Zambia.
authors.forename: Victor M
authors.initials: VM
authors.lastname: Mukonka
authors.affiliation: Institute of Disease Control and Prevention, Center for Disease Control, Beijing, People's Republic of China.
authors.forename: Wenyi
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Zambian Ministry of Environment and Statistics, Lusaka, Zambia.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Mushinge
authors.affiliation: Ministry of Health, National Malaria Control Centre, Lusaka, Zambia.
authors.forename: Mercy
authors.initials: M
authors.lastname: Mwanza-Ingwe
authors.affiliation: Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA Department of Geography, University of Florida, Gainesville, FL, USA ubydul.kth@gmail.com.
authors.forename: Ubydul
authors.initials: U
authors.lastname: Haque
mesh_terms: D000328:Adult; D000962:Antimalarials / Q000627:therapeutic use; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D057148:Insecticide-Treated Bednets / Q000706:statistics & numerical data*; D007306:Insecticides; D008288:Malaria / Q000517:prevention & control / Q000635:transmission*; D015233:Models, Statistical; D009032:Mosquito Control / Q000458:organization & administration*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000097:blood / Q000517:prevention & control*; D015995:Prevalence; D062486:Public Health Surveillance; D015024:Zambia / Q000453:epidemiology
chemical_list: D000962:Antimalarials; D007306:Insecticides
keywords: Diagnosis; IPTp; Malaria; Pregnancy; Risk factors; Zambia