Denis Valle|Joanna M. Tucker Lima
Large-scale drivers of malaria and priority areas for prevention and control in the Brazilian Amazon region using a novel multi-pathogen geospatial model
University of Florida|University of Florida
malaria burden americas concentrated brazilian amazon detailed spatial characterization malaria risk yet undertaken utilizing 20042008 malaria incidence data collected six brazilian amazon states largescale spatial patterns malaria risk characterized novel bayesian multipathogen geospatial model data included 24 million malaria cases spread across 36 million sq km remotely sensed variables deforestation rate forest cover rainfall dry season length proximity large water bodies socioeconomic variables rural population size income literacy rate mortality rate children age five migration patterns gis variables proximity roads hydroelectric dams gold mining operations incorporated covariates borrowing information across pathogens allowed better spatial predictions malaria caused plasmodium falciparum evidenced tenfold crossvalidation malaria incidence plasmodium vivax p falciparum tended higher areas greater forest cover proximity gold mining operations another important risk factor corroborated positive association migration rates malaria incidence finally areas longer dry season areas higher average rural income tended higher malaria risk risk maps reveal striking spatial heterogeneity malaria risk across region yet mean disease risk surface maps misleading uncertainty ignored combining mean spatial predictions associated uncertainty several sites consistently classified hotspots suggesting importance priority areas malaria prevention control article provides several contributions methodological perspective benefits jointly modelling multiple pathogens spatial predictions illustrated addition maps mean disease risk contrasted statistically significant disease clusters highlighting critical importance uncertainty determining disease hotspots epidemiological perspective forest cover proximity gold mining operations important largescale drivers disease risk region finally hotspot western acre identified area receive highest priority brazilian national malaria prevention control programme