title: A geostatistical analysis of the association between armed conflicts and Plasmodium falciparum malaria in Africa, 1997-2010.
abstract: BACKGROUND
  The absence of conflict in a country has been cited as a crucial factor affecting the operational feasibility of achieving malaria control and elimination, yet mixed evidence exists on the influence that conflicts have had on malaria transmission. Over the past two decades, Africa has seen substantial numbers of armed conflicts of varying length and scale, creating conditions that can disrupt control efforts and impact malaria transmission. However, very few studies have quantitatively assessed the associations between conflicts and malaria transmission, particularly in a consistent way across multiple countries.
  
  
  METHODS
  In this analysis an explicit geostatistical, autoregressive, mixed model is employed to quantitatively assess the association between conflicts and variations in Plasmodium falciparum parasite prevalence across a 13-year period in sub-Saharan Africa.
  
  
  RESULTS
  Analyses of geolocated, malaria prevalence survey variations against armed conflict data in general showed a wide, but short-lived impact of conflict events geographically. The number of countries with decreased P. falciparum parasite prevalence (17) is larger than the number of countries with increased transmission (12), and notably, some of the countries with the highest transmission pre-conflict were still found with lower transmission post-conflict. For four countries, there were no significant changes in parasite prevalence. Finally, distance from conflicts, duration of conflicts, violence of conflict, and number of conflicts were significant components in the model explaining the changes in P. falciparum parasite rate.
  
  
  CONCLUSIONS
  The results suggest that the maintenance of intervention coverage and provision of healthcare in conflict situations to protect vulnerable populations can maintain gains in even the most difficult of circumstances, and that conflict does not represent a substantial barrier to elimination goals.
authors.affiliation: CHICAS, Lancaster Medical School, Lancaster University, Furness Building, Lancaster, LA1 4YG, UK. l.sedda@lancaster.ac.uk.
authors.forename: Luigi
authors.initials: L
authors.lastname: Sedda
authors.affiliation: Department of Geography, University of Florida, Gainesville, FL, 32611-7315, USA. qiqiuyin1986@gmail.com.
authors.forename: Qiuyin
authors.initials: Q
authors.lastname: Qi
authors.affiliation: Fogarty International Center, National Institutes of Health, Bethesda, MD, 20892, USA. A.J.Tatem@soton.ac.uk.|Flowminder Foundation, Roslagsgatan 17, 113 55, Stockholm, Sweden. A.J.Tatem@soton.ac.uk.|Geography and Environment, University of Southampton, University Road, Southampton, SO17 1BJ, UK. A.J.Tatem@soton.ac.uk.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Tatem
mesh_terms: D017954:Africa South of the Sahara / Q000453:epidemiology; D000068337:Armed Conflicts; D056808:Biostatistics; D003140:Communicable Disease Control / Q000379:methods; D018562:Disease Transmission, Infectious / Q000517:prevention & control; D006801:Humans; D016778:Malaria, Falciparum / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D062211:Spatio-Temporal Analysis; D019371:Topography, Medical