title: Deforestation, drainage network, indigenous status, and geographical differences of malaria in the State of Amazonas.
abstract: BACKGROUND
  Malaria is a major public health problem worldwide. In Brazil, an average of 420,000 cases of malaria have been reported annually in the last 12 years, of which 99.7 % occurred in the Amazon region. This study aimed to analyse the distribution of malaria in the State of Amazonas and the influence of indigenous malaria in this scenario, to evaluate the correlation between incidence rates and socio-economic and environmental factors, and to evaluate the performance of health surveillance services.
  
  
  METHODS
  This ecological study used secondary data obtained from the SIVEP-MALARIA malaria surveillance programme. The relationship between demographic, socio-economic and environmental factors, the performance of health surveillance services and the incidence of malaria in Amazonas, a multiple linear regression model was used.
  
  
  RESULTS
  The crude rate of malaria in Amazonas was 4142.72 cases per 100,000 inhabitants between 2003 and 2012. The incidence rates for the indigenous and non-indigenous populations were 12,976.02 and 3749.82, respectively, with an indigenous population attributable fraction of only 8 %. The results of the linear regression analysis indicated a negative correlation between the two socio-economic indicators (municipal human development index (MHDI) and poverty rate) and the incidence of malaria in the period. With regard to the environmental indicators (average annual deforestation rate and percentage of areas under the influence of watercourses), the correlation with the incidence rate was positive.
  
  
  CONCLUSIONS
  The findings underscore the importance of implementing economic and social development policies articulated with strategic actions of environmental protection and health care for the population.
authors.affiliation: Fundação de Vigilância em Saúde do Amazonas, Manaus, Brazil. wagner.terrazas@gmail.com.
authors.forename: Wagner Cosme Morhy
authors.initials: WC
authors.lastname: Terrazas
authors.affiliation: Fundação de Vigilância em Saúde do Amazonas, Manaus, Brazil. vandersons@gmail.com.
authors.forename: Vanderson de Souza
authors.initials: Vde S
authors.lastname: Sampaio
authors.affiliation: Fundação de Vigilância em Saúde do Amazonas, Manaus, Brazil. danielbarrosbio@gmail.com.|Escola Nacional de Saúde Pública Sergio Arouca, FIOCRUZ, Rio de Janeiro, Brazil. danielbarrosbio@gmail.com.
authors.forename: Daniel Barros
authors.initials: DB
authors.lastname: de Castro
authors.affiliation: Fundação de Vigilância em Saúde do Amazonas, Manaus, Brazil. rosemary.pinto@gmail.com.
authors.forename: Rosemary Costa
authors.initials: RC
authors.lastname: Pinto
authors.affiliation: Fundação de Vigilância em Saúde do Amazonas, Manaus, Brazil. bernardclaudio@uol.com.br.
authors.forename: Bernardino Cláudio
authors.initials: BC
authors.lastname: de Albuquerque
authors.affiliation: Fundação de Vigilância em Saúde do Amazonas, Manaus, Brazil. megsadahiro@gmail.com.
authors.forename: Megumi
authors.initials: M
authors.lastname: Sadahiro
authors.affiliation: Fundação de Vigilância em Saúde do Amazonas, Manaus, Brazil. ricardo.fvs@gmail.com.
authors.forename: Ricardo Augusto
authors.initials: RA
authors.lastname: Dos Passos
authors.affiliation: Escola Nacional de Saúde Pública Sergio Arouca, FIOCRUZ, Rio de Janeiro, Brazil. ueleres@gmail.com.|Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil. ueleres@gmail.com.|PVS PECTI-SAÚDE/Fundação de Amparo à Pesquisa do Estado do Amazonas (FAPEAM), Manaus, Amazonas, Brazil. ueleres@gmail.com.
authors.forename: José Ueleres
authors.initials: JU
authors.lastname: Braga
mesh_terms: D001938:Brazil / Q000453:epidemiology; D003247:Conservation of Natural Resources / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D016014:Linear Models; D008288:Malaria / Q000453:epidemiology / Q000635:transmission; D045483:Rivers; D012959:Socioeconomic Factors; D062206:Spatial Analysis