title: Plasmodium falciparum malaria importation from Africa to China and its mortality: an analysis of driving factors.
abstract: Plasmodium falciparum malaria importation from Africa to China is rising with increasing Chinese overseas investment and international travel. Identifying networks and drivers of this phenomenon as well as the contributors to high case-fatality rate is a growing public health concern to enable efficient response. From 2011-2015, 8653 P. falciparum cases leading to 98 deaths (11.3 per 1000 cases) were imported from 41 sub-Saharan countries into China, with most cases (91.3%) occurring in labour-related Chinese travellers. Four strongly connected groupings of origin African countries with destination Chinese provinces were identified, and the number of imported cases was significantly associated with the volume of air passengers to China (P = 0.006), parasite prevalence in Africa (P < 0.001), and the amount of official development assistance from China (P < 0.001) with investment in resource extraction having the strongest relationship with parasite importation. Risk factors for deaths from imported cases were related to the capacity of malaria diagnosis and diverse socioeconomic factors. The spatial heterogeneity uncovered, principal drivers explored, and risk factors for mortality found in the rising rates of P. falciparum malaria importation to China can serve to refine malaria elimination strategies and the management of cases, and high risk groups and regions should be targeted.
authors.affiliation: WorldPop, Department of Geography and Environment, University of Southampton, Southampton SO17 1BJ, UK.|Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing 102206, China.|Flowminder Foundation, Stockholm, Sweden.
authors.forename: Shengjie
authors.initials: S
authors.lastname: Lai
authors.affiliation: WorldPop, Department of Geography and Environment, University of Southampton, Southampton SO17 1BJ, UK.|Flowminder Foundation, Stockholm, Sweden.
authors.forename: Nicola A
authors.initials: NA
authors.lastname: Wardrop
authors.affiliation: Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
authors.forename: Zhuojie
authors.initials: Z
authors.lastname: Huang
authors.affiliation: WorldPop, Department of Geography and Environment, University of Southampton, Southampton SO17 1BJ, UK.|Flowminder Foundation, Stockholm, Sweden.
authors.forename: Claudio
authors.initials: C
authors.lastname: Bosco
authors.affiliation: Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
authors.forename: Junling
authors.initials: J
authors.lastname: Sun
authors.affiliation: WorldPop, Department of Geography and Environment, University of Southampton, Southampton SO17 1BJ, UK.|Flowminder Foundation, Stockholm, Sweden.
authors.forename: Tomas
authors.initials: T
authors.lastname: Bird
authors.affiliation: Department of Ecology and Evolutionary Biology, Princeton University, New Jersey, USA.|Center for Communicable Disease Dynamics, Harvard T. H. Chan School of Public Health, Boston, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Wesolowski
authors.affiliation: Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
authors.forename: Sheng
authors.initials: S
authors.lastname: Zhou
authors.affiliation: Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
authors.forename: Qian
authors.initials: Q
authors.lastname: Zhang
authors.affiliation: Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
authors.forename: Canjun
authors.initials: C
authors.lastname: Zheng
authors.affiliation: Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
authors.forename: Zhongjie
authors.initials: Z
authors.lastname: Li
authors.affiliation: WorldPop, Department of Geography and Environment, University of Southampton, Southampton SO17 1BJ, UK.|Flowminder Foundation, Stockholm, Sweden.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Tatem
authors.affiliation: School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China.
authors.forename: Hongjie
authors.initials: H
authors.lastname: Yu
mesh_terms: D000328:Adult; D000349:Africa / Q000453:epidemiology; D002681:China / Q000453:epidemiology; D016208:Databases, Factual; D005260:Female; D005843:Geography; D006801:Humans; D016778:Malaria, Falciparum / Q000453:epidemiology* / Q000401:mortality* / Q000635:transmission*; D008297:Male; D008875:Middle Aged; D010963:Plasmodium falciparum; D015995:Prevalence; D011634:Public Health; D012307:Risk Factors; D014195:Travel