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Spatial–temporal clustering of malaria using routinely collected health facility data on the Kenyan Coast

Authors :
Alice Kamau
Grace Mtanje
Christine Mataza
Philip Bejon
Robert W. Snow
Source :
Malaria Journal, Vol 20, Iss 1, Pp 1-13 (2021)
Publication Year :
2021
Publisher :
BMC, 2021.

Abstract

Abstract Background The over-distributed pattern of malaria transmission has led to attempts to define malaria “hotspots” that could be targeted for purposes of malaria control in Africa. However, few studies have investigated the use of routine health facility data in the more stable, endemic areas of Africa as a low-cost strategy to identify hotspots. Here the objective was to explore the spatial and temporal dynamics of fever positive rapid diagnostic test (RDT) malaria cases routinely collected along the Kenyan Coast. Methods Data on fever positive RDT cases between March 2018 and February 2019 were obtained from patients presenting to six out-patients health-facilities in a rural area of Kilifi County on the Kenyan Coast. To quantify spatial clustering, homestead level geocoded addresses were used as well as aggregated homesteads level data at enumeration zone. Data were sub-divided into quarterly intervals. Kulldorff’s spatial scan statistics using Bernoulli probability model was used to detect hotspots of fever positive RDTs across all ages, where cases were febrile individuals with a positive test and controls were individuals with a negative test. Results Across 12 months of surveillance, there were nine significant clusters that were identified using the spatial scan statistics among RDT positive fevers. These clusters included 52% of all fever positive RDT cases detected in 29% of the geocoded homesteads in the study area. When the resolution of the data was aggregated at enumeration zone (village) level the hotspots identified were located in the same areas. Only two of the nine hotspots were temporally stable accounting for 2.7% of the homesteads and included 10.8% of all fever positive RDT cases detected. Conclusion Taking together the temporal instability of spatial hotspots and the relatively modest fraction of the malaria cases that they account for; it would seem inadvisable to re-design the sub-county control strategies around targeting hotspots.

Details

Language :
English
ISSN :
14752875
Volume :
20
Issue :
1
Database :
Directory of Open Access Journals
Journal :
Malaria Journal
Publication Type :
Academic Journal
Accession number :
edsdoj.7fcb3b72c38046579dda2f2140c74162
Document Type :
article
Full Text :
https://doi.org/10.1186/s12936-021-03758-3