Department of Immunology, College of Basic Medical Sciences, China Medical University, Shenyang, 110122, Liaoning, China.
Myanmar Health Network Organization, Yangon, Myanmar.
Infect Dis Poverty. 2023 Jan 28;12(1):2. doi: 10.1186/s40249-023-01055-6.
BACKGROUND: Myanmar bears the heaviest malaria burden in the Greater Mekong Subregion (GMS). This study assessed the spatio-temporal dynamics and environmental predictors of Plasmodium falciparum and Plasmodium vivax malaria in Myanmar. METHODS: Monthly reports of malaria cases at primary health centers during 2011-2017 were analyzed to describe malaria distribution across Myanmar at the township and state/region levels by spatial autocorrelation (Moran index) and spatio-temporal clustering. Negative binomial generalized additive models identified environmental predictors for falciparum and vivax malaria, respectively. RESULTS: From 2011 to 2017, there was an apparent reduction in malaria incidence in Myanmar. Malaria incidence peaked in June each year. There were significant spatial autocorrelation and clustering with extreme spatial heterogeneity in malaria cases and test positivity across the nation (P < 0.05). Areas with higher malaria incidence were concentrated along international borders. Primary clusters of P. falciparum persisted in western townships, while clusters of P. vivax shifted geographically over the study period. The primary cluster was detected from January 2011 to December 2013 and covered two states (Sagaing and Kachin). Annual malaria incidence was highest in townships with a mean elevation of 500‒600 m and a high variance in elevation (states with both high and low elevation). There was an apparent linear relationship between the mean normalized difference vegetative index and annual P. falciparum incidence (P < 0.05). CONCLUSION: The decreasing trends reflect the significant achievement of malaria control efforts in Myanmar. Prioritizing the allocation of resources to high-risk areas identified in this study can achieve effective disease control.
背景:缅甸是大湄公河次区域(GMS)中疟疾负担最重的国家。本研究评估了缅甸间日疟原虫和恶性疟原虫疟疾的时空动态和环境预测因子。
方法:分析了 2011-2017 年基层医疗中心每月的疟疾报告,通过空间自相关(莫兰指数)和时空聚类来描述缅甸各县和州/地区的疟疾分布情况。负二项广义加性模型分别确定了间日疟原虫和恶性疟原虫的环境预测因子。
结果:2011 年至 2017 年间,缅甸的疟疾发病率明显下降。疟疾发病率每年 6 月达到峰值。全国疟疾病例和检测阳性率存在显著的空间自相关和聚类,具有极高的空间异质性(P<0.05)。高疟疾发病率地区集中在边境沿线。西缅的恶性疟原虫原发性聚集持续存在,而间日疟原虫的聚集区域在研究期间发生了变化。原发性聚集区于 2011 年 1 月至 2013 年 12 月出现,覆盖两个邦(实皆邦和克钦邦)。海拔 500-600 米、海拔差异较大(高海拔和低海拔地区都有)的乡镇疟疾年发病率最高。归一化植被指数与恶性疟原虫年发病率之间存在明显的线性关系(P<0.05)。
结论:下降趋势反映了缅甸在疟疾控制方面取得的重大成就。在本研究中确定的高风险地区优先分配资源,可以实现有效的疾病控制。
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