title: Spatio-temporal analysis of malaria incidence in the Peruvian Amazon Region between 2002 and 2013.
abstract: Malaria remains a major public health problem in the Peruvian Amazon where the persistence of high-risk transmission areas (hotspots) challenges the current malaria control strategies. This study aimed at identifying significant space-time clusters of malaria incidence in Loreto region 2002-2013 and to determine significant changes across years in relation to the control measures applied. Poisson regression and purely temporal, spatial, and space-time analyses were conducted. Three significantly different periods in terms of annual incidence rates (AIR) were identified, overlapping respectively with the pre-, during, and post- implementation control activities supported by PAMAFRO project. The most likely space-time clusters of malaria incidence for P. vivax and P. falciparum corresponded to the pre- and first two years of the PAMAFRO project and were situated in the northern districts of Loreto, while secondary clusters were identified in eastern and southern districts with the latest onset and the shortest duration of PAMAFRO interventions. Malaria in Loreto was highly heterogeneous at geographical level and over time. Importantly, the excellent achievements obtained during 5 years of intensified control efforts totally vanished in only 2 to 3 years after the end of the program, calling for sustained political and financial commitment for the success of malaria elimination as ultimate goal.
authors.affiliation: Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima 31, Perú.
authors.forename: Veronica
authors.initials: V
authors.lastname: Soto-Calle
authors.affiliation: Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima 31, Perú.|Research Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels 1200, Belgium.
authors.forename: Angel
authors.initials: A
authors.lastname: Rosas-Aguirre
authors.affiliation: Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima 31, Perú.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Llanos-Cuentas
authors.affiliation: Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp 2000, Belgium.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Abatih
authors.affiliation: Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp 2000, Belgium.
authors.forename: Redgi
authors.initials: R
authors.lastname: DeDeken
authors.affiliation: Dirección Regional de Salud Loreto DIRESA Loreto, Loreto 160, Perú.
authors.forename: Hugo
authors.initials: H
authors.lastname: Rodriguez
authors.affiliation: Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp 2000, Belgium.
authors.forename: Anna
authors.initials: A
authors.lastname: Rosanas-Urgell
authors.affiliation: Departamento de Ciencias Celulares y Moleculares, Facultad de Ciencias y Filosofia, Universidad Peruana Cayetano Heredia, Lima 31, Perú.
authors.forename: Dionicia
authors.initials: D
authors.lastname: Gamboa
authors.affiliation: Disease Control and Elimination, Medical Research Council Unit, Fajara 220, The Gambia.|London School of Hygiene &Tropical Medicine, London WC1E 7HT, UK.|Department of Public Health, Institute of Tropical Medicine, Antwerp 2000, Belgium.
authors.forename: Umberto
authors.initials: U
authors.lastname: D Alessandro
authors.affiliation: Disease Control and Elimination, Medical Research Council Unit, Fajara 220, The Gambia.|Department of Public Health, Institute of Tropical Medicine, Antwerp 2000, Belgium.
authors.forename: Annette
authors.initials: A
authors.lastname: Erhart
authors.affiliation: Research Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels 1200, Belgium.
authors.forename: Niko
authors.initials: N
authors.lastname: Speybroeck
mesh_terms: D016000:Cluster Analysis; D005843:Geography; D006801:Humans; D015994:Incidence; D008288:Malaria / Q000453:epidemiology* / Q000469:parasitology; D016778:Malaria, Falciparum / Q000453:epidemiology / Q000469:parasitology; D016780:Malaria, Vivax / Q000453:epidemiology / Q000469:parasitology; D010568:Peru / Q000453:epidemiology; D010963:Plasmodium falciparum / Q000502:physiology; D010966:Plasmodium vivax / Q000502:physiology; D062211:Spatio-Temporal Analysis