A geostatistical analysis of the association between armed conflicts and Plasmodium falciparum malaria in Africa, 1997–2010

Malaria Journal

Research

Luigi Sedda¹  Qiuyin Qi²  Andrew J. Tatem³ 

[1] CHICAS, Lancaster Medical School, Lancaster University, Furness Building, LA1 4YG, Lancaster, UK;Department of Geography, University of Florida, 32611-7315, Gainesville, FL, USA;Fogarty International Center, National Institutes of Health, 20892, Bethesda, MD, USA;Flowminder Foundation, Roslagsgatan 17, 113 55, Stockholm, Sweden;Geography and Environment, University of Southampton, University Road, SO17 1BJ, Southampton, UK;

关键词: Plasmodium falciparum;    Conflict density;    Violence;    Variogram;    Malaria control;   

DOI  :  10.1186/s12936-015-1024-5

 received in 2015-09-26, accepted in 2015-11-27,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundThe absence of conflict in a country has been cited as a crucial factor affecting the operational feasibility of achieving malaria control and elimination, yet mixed evidence exists on the influence that conflicts have had on malaria transmission. Over the past two decades, Africa has seen substantial numbers of armed conflicts of varying length and scale, creating conditions that can disrupt control efforts and impact malaria transmission. However, very few studies have quantitatively assessed the associations between conflicts and malaria transmission, particularly in a consistent way across multiple countries.MethodsIn this analysis an explicit geostatistical, autoregressive, mixed model is employed to quantitatively assess the association between conflicts and variations in Plasmodium falciparum parasite prevalence across a 13-year period in sub-Saharan Africa.ResultsAnalyses of geolocated, malaria prevalence survey variations against armed conflict data in general showed a wide, but short-lived impact of conflict events geographically. The number of countries with decreased P. falciparum parasite prevalence (17) is larger than the number of countries with increased transmission (12), and notably, some of the countries with the highest transmission pre-conflict were still found with lower transmission post-conflict. For four countries, there were no significant changes in parasite prevalence. Finally, distance from conflicts, duration of conflicts, violence of conflict, and number of conflicts were significant components in the model explaining the changes in P. falciparum parasite rate.ConclusionsThe results suggest that the maintenance of intervention coverage and provision of healthcare in conflict situations to protect vulnerable populations can maintain gains in even the most difficult of circumstances, and that conflict does not represent a substantial barrier to elimination goals.

【 授权许可】

CC BY   
© Sedda et al. 2015

【 图 表 】

12951_2016_171_Article_IEq5.gif

12951_2016_171_Article_IEq3.gif

Fig. 10

12936_2023_4742_Article_IEq36.gif

12936_2023_4742_Article_IEq20.gif

Fig. 2

12951_2017_255_Article_IEq56.gif

Fig. 3

Fig. 1

12951_2017_255_Article_IEq53.gif

Fig. 4

Fig. 6

Fig. 2

Fig. 1

Fig. 3

Fig. 3