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Risk Factors for Border Malaria in a Malaria Elimination Setting: A Retrospective Case-Control Study in Yunnan, China

Jian-Wei XuYunnan Institute of Parasitic Diseases, Yunnan Provincial Center of Malaria Research, Yunnan Provincial Collaborative Innovation Center for Public Health and Disease Prevention and Control, Yunnan Provincial Key Laboratory of Vector-Borne Diseases Control and Research, Puer 665000, China; The Fourth Hospital of Baotou Municipality, Inner Mongolia, Baotou, China; Yingjiang County Center for Disease Control and Prevention, Yingjiang China; Tengchong County Center for Disease Control and Prevention, Tengchong, China

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Hui LiuYunnan Institute of Parasitic Diseases, Yunnan Provincial Center of Malaria Research, Yunnan Provincial Collaborative Innovation Center for Public Health and Disease Prevention and Control, Yunnan Provincial Key Laboratory of Vector-Borne Diseases Control and Research, Puer 665000, China; The Fourth Hospital of Baotou Municipality, Inner Mongolia, Baotou, China; Yingjiang County Center for Disease Control and Prevention, Yingjiang China; Tengchong County Center for Disease Control and Prevention, Tengchong, China

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Yu ZhangYunnan Institute of Parasitic Diseases, Yunnan Provincial Center of Malaria Research, Yunnan Provincial Collaborative Innovation Center for Public Health and Disease Prevention and Control, Yunnan Provincial Key Laboratory of Vector-Borne Diseases Control and Research, Puer 665000, China; The Fourth Hospital of Baotou Municipality, Inner Mongolia, Baotou, China; Yingjiang County Center for Disease Control and Prevention, Yingjiang China; Tengchong County Center for Disease Control and Prevention, Tengchong, China

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Xiang-Rui GuoYunnan Institute of Parasitic Diseases, Yunnan Provincial Center of Malaria Research, Yunnan Provincial Collaborative Innovation Center for Public Health and Disease Prevention and Control, Yunnan Provincial Key Laboratory of Vector-Borne Diseases Control and Research, Puer 665000, China; The Fourth Hospital of Baotou Municipality, Inner Mongolia, Baotou, China; Yingjiang County Center for Disease Control and Prevention, Yingjiang China; Tengchong County Center for Disease Control and Prevention, Tengchong, China

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Jia-Zhi WangYunnan Institute of Parasitic Diseases, Yunnan Provincial Center of Malaria Research, Yunnan Provincial Collaborative Innovation Center for Public Health and Disease Prevention and Control, Yunnan Provincial Key Laboratory of Vector-Borne Diseases Control and Research, Puer 665000, China; The Fourth Hospital of Baotou Municipality, Inner Mongolia, Baotou, China; Yingjiang County Center for Disease Control and Prevention, Yingjiang China; Tengchong County Center for Disease Control and Prevention, Tengchong, China

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A retrospective case-control study was conducted to identify risk factors for border malaria in a malaria elimination setting of Yunnan Province, China. The study comprised 214 cases and 428 controls. The controls were individually matched to the cases on the basis of residence, age, and gender. In addition, statistical associations are based on matched analyses. The frequencies of imported, male, adult, and vivax malaria cases were respectively 201 (93.9%), 194 (90.7%), 210 (98.1%), and 176 (82.2%). Overnight stay in Myanmar within the prior month was independently associated with malaria infection (odds ratio [OR] 159.5, 95% confidence interval [CI] 75.1–338.9). In particular, stays in lowland and foothill (OR 5.5, 95% CI 2.5–11.8) or mid-hill (OR 42.8, 95% CI 5.1–319.8) areas, or near streamlets (OR 15.3, 95% CI 4.3–55.2) or paddy field or pools (OR10.1, 95% CI 4.4–55.8) were found to be independently associated with malaria. Neither forest exposure nor use of vector control measures was associated with malaria. In conclusion, travel to lowland and foothill or mid-hill hyperendemic areas, especially along the waterside in Myanmar, was found to be the highest risk factor for malaria. In considering the limitations of the study, further investigations are needed to identify the major determinants of malaria risk and develop new strategies for malaria elimination on China-Myanmar border.

Author Notes

* Address correspondence to Hui Liu, Yunnan Institute of Parasitic Diseases, 6 Xiyuan Road, Puer, 665000, Yunnan, China. E-mail: liubible@126.com

Financial support: This study was funded by a grant to China National Strategy Application of the Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM/CHN-S10-G13-M).

Authors' addresses: Jian-Wei Xu and Hui Liu, Yunnan Institute of Parasitic Diseases, Malaria Division, Puer, China, E-mails: xjw426@163.com and liubible@126.com. Yu Zhang, The Fourth Hospital of Baotou Municipality, Clinical Laboratory, Baotou, China, E-mail: 905049522@qq.com. Xiang-Rui Guo, Yingjiang County Center for Disease Prevention and Control, Division of Parasitic Diseases, Yingjiang, China, E-mail: fangwenyan50537405@qq.com. Jia-Zhi Wang, Tengchong County Center for Disease Prevention and Control, Division of Parasitic Diseases, Division of Parasitic Diseases, Tengchong, China, E-mail: tcwangjiazhi@yahoo.com.cn.

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