Swiss Tropical and Public Health Institute, Allschwil, Switzerland.
University of Basel, Basel, Switzerland.
Infect Dis Poverty. 2024 Sep 16;13(1):67. doi: 10.1186/s40249-024-01237-w.
Despite global efforts to reduce and eventually interrupt malaria transmission, the disease remains a pressing public health problem, especially in sub-Saharan Africa. This study presents a detailed spatio-temporal analysis of malaria transmission in Rwanda from 2012 to 2022. The main objective was to gain insights into the evolving patterns of malaria and to inform and tailor effective public health strategies.
The study used yearly aggregated data of malaria cases from the Rwanda health management information system. We employed a multifaceted analytical approach, including descriptive statistics and spatio-temporal analysis across three demographic groups: children under the age of 5 years, and males and females above 5 years. Bayesian spatially explicit models and spatio scan statistics were utilised to examine geographic and temporal patterns of relative risks and to identify clusters of malaria transmission.
We observed a significant increase in malaria cases from 2014 to 2018, peaking in 2016 for males and females aged above 5 years with counts of 98,645 and 116,627, respectively and in 2018 for under 5-year-old children with 84,440 cases with notable geographic disparities. Districts like Kamonyi (Southern Province), Ngoma, Kayonza and Bugesera (Eastern Province) exhibited high burdens, possibly influenced by factors such as climate, vector control practices, and cross-border dynamics. Bayesian spatially explicit modeling revealed elevated relative risks in numerous districts, underscoring the heterogeneity of malaria transmission in these districts, and thus contributing to an overall rising trend in malaria cases until 2018, followed by a subsequent decline. Our findings emphasize that the heterogeneity of malaria transmission is potentially driven by ecologic, socioeconomic, and behavioural factors.
The study underscores the complexity of malaria transmission in Rwanda and calls for climate adaptive, gender-, age- and district-specific strategies in the national malaria control program. The emergence of both artemisinin and pyrethoids resistance and persistent high transmission in some districts necessitates continuous monitoring and innovative, data-driven approaches for effective and sustainable malaria control.
尽管全球各国都在努力减少甚至阻断疟疾传播，但这种疾病仍是一个紧迫的公共卫生问题，尤其是在撒哈拉以南非洲地区。本研究对 2012 年至 2022 年期间卢旺达的疟疾传播进行了详细的时空分析。主要目的是深入了解疟疾的流行模式，并为制定和调整有效的公共卫生策略提供信息。
本研究使用了来自卢旺达卫生管理信息系统的疟疾年度汇总数据。我们采用了多方面的分析方法，包括描述性统计和三个年龄组（5 岁以下儿童、5 岁以上男性和女性）的时空分析。我们还使用贝叶斯空间显式模型和时空扫描统计来检查相对风险的地理和时间模式，并确定疟疾传播的集群。
我们发现，2014 年至 2018 年期间，疟疾病例显著增加，2016 年达到高峰，5 岁以上男性和女性的疟疾病例数分别为 98645 例和 116627 例，2018 年 5 岁以下儿童的疟疾病例数为 84440 例，存在显著的地理差异。卡莫尼（南部省）、恩戈马、卡扬扎和布盖塞拉（东部省）等地区的疟疾病例负担较高，这可能受到气候、病媒控制措施和跨境动态等因素的影响。贝叶斯空间显式模型显示，许多地区的相对风险增加，突显了这些地区疟疾传播的异质性，从而导致疟疾病例总体呈上升趋势，直到 2018 年才有所下降。本研究结果强调，疟疾传播的异质性可能是由生态、社会经济和行为因素驱动的。
本研究强调了卢旺达疟疾传播的复杂性，并呼吁国家疟疾控制计划采取适应气候、兼顾性别、年龄和地区的策略。青蒿素和拟除虫菊酯类药物的耐药性出现以及一些地区持续高传播的情况，需要持续监测并采取创新的、基于数据的方法，以实现有效和可持续的疟疾控制。
