title: Time trend of malaria in relation to climate variability in Papua New Guinea.
abstract: OBJECTIVE
  This study was conducted to describe the regional malaria incidence in relation to the geographic and climatic conditions and describe the effect of altitude on the expansion of malaria over the last decade in Papua New Guinea.
  
  
  METHODS
  Malaria incidence was estimated in five provinces from 1996 to 2008 using national health surveillance data. Time trend of malaria incidence was compared with rainfall and minimum/maximum temperature. In the Eastern Highland Province, time trend of malaria incidence over the study period was stratified by altitude. Spatio-temporal pattern of malaria was analyzed.
  
  
  RESULTS
  Nationwide, malaria incidence was stationary. Regionally, the incidence increased markedly in the highland region (292.0/100000/yr, p =0.021), and remained stationary in the other regions. Seasonality of the malaria incidence was related with rainfall. Decreasing incidence of malaria was associated with decreasing rainfall in the southern coastal region, whereas it was not evident in the northern coastal region. In the Eastern Highland Province, malaria incidence increased in areas below 1700 m, with the rate of increase being steeper at higher altitudes.
  
  
  CONCLUSIONS
  Increasing trend of malaria incidence was prominent in the highland region of Papua New Guinea, while long-term trend was dependent upon baseline level of rainfall in coastal regions.
authors.affiliation: Department of Microbiology, Graduate School of Medicine, Gachon University of Medicine and Science, Incheon, Korea.
authors.forename: Jae-Won
authors.identifier: 0000-0002-5959-7628
authors.initials: JW
authors.lastname: Park
authors.affiliation: Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon, Korea.
authors.forename: Hae-Kwan
authors.identifier: 0000-0003-2758-9399
authors.initials: HK
authors.lastname: Cheong
authors.affiliation: Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan.
authors.forename: Yasushi
authors.identifier: 0000-0003-2248-1629
authors.initials: Y
authors.lastname: Honda
authors.affiliation: Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, Korea.
authors.forename: Mina
authors.identifier: 0000-0003-1011-9446
authors.initials: M
authors.lastname: Ha
authors.affiliation: Department of Biostatistics and Epidemiology, Graduate School of Public Health, and Institute of Public Health and Environment, Seoul National University, Seoul, Korea.
authors.forename: Ho
authors.identifier: 0000-0001-7472-3752
authors.initials: H
authors.lastname: Kim
authors.affiliation: National Department of Health, Port Moresby, Papua New Guinea.
authors.forename: Joel
authors.initials: J
authors.lastname: Kolam
authors.affiliation: National Weather Service, Port Moresby, Papua New Guinea.
authors.forename: Kasis
authors.initials: K
authors.lastname: Inape
authors.affiliation: Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
authors.forename: Ivo
authors.identifier: 0000-0001-6554-6889
authors.initials: I
authors.lastname: Mueller
keywords: Asia-Pacific; Climate change; Descriptive epidemiology; Highland; Malaria; Time trend; Tropical area; Vector-borne diseases