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Spatiotemporal cluster analysis of malaria incidence in Pakistan, 2011-2016

Muhammad Farooq Umer

Aim: Despite remarkable progress, malaria remains a grave public health concern in Pakistan. Very few studies are available on spatiotemporal evaluation of malaria in Pakistan. This study aimed to detect the spatiotemporal pattern of malaria infection in Pakistan at district level, and to identify the clusters of highrisk disease areas in the country.

Methods: District level annual (2011-2016) case data for three types of malaria (P.falciparum, P.vivax and mixed Plasmodium) were obtained from Directorate of Malaria Control Program, Pakistan. Population data were downloaded from Pakistan Bureau of Statistics. Geographical information system (GIS) was used to display the spatiotemporal distribution of malaria (incidence rate, relative risk, primary & secondary clusters) at district level throughout Pakistan. Purely spatiotemporal clustering analysis was performed to identify high-risk areas of malaria infection in Pakistan.

Results: A total of 1,593,409 positive cases were included in this study. Maximum number of P.vivax cases (474,478) was reported in Khyber Pakhtunkhwa (KPK). Highest burden of P.falciparum (145,445) was in Balochistan while highest count of mixed Plasmodium cases was reported in Sindh (22,421) and Balochistan (22,229), respectively. Cluster analysis showed that primary clusters of P.vivax malaria included same districts in 2014, 15 and 16 (total 24 districts, 12 in FATA, 9 in KPK, 2 in Punjab and 1 in Balochistan); and those of P.falciparum malaria were unchanged in 2012 and 13 (total 18 districts, all in Balochistan). While most significant high-risk districts for mixed Plasmodium malaria were same in 2014 and 15 (total 7 districts, 6 in Balochistan and 1 in FATA).

Conclusion: This study exhibited the transmission cycles of malaria infection vary in different spatiotemporal settings in Pakistan. Efforts to control most prevalent P.vivax malaria need to be enhanced. Further research is needed to investigate the impact of risk factors on transmission of malaria in Pakistan.

Note: This work was presented in 8^th Edition of International Conference on Infectious Diseases scheduled during June 07-08, 2018 in London, UK