Detecting Malaria Hotspots in Haiti, a Low-Transmission Setting

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  • 1 Centers for Disease Control and Prevention, Division of Global Health Protection, Atlanta, Georgia;
  • 2 Ministry of Public Health and Population, National Malaria Control Program, Port-au-Prince, Haiti;
  • 3 Centers for Disease Control and Prevention, Division of Parasitic Disease and Malaria, Atlanta, Georgia

In 2006, Haiti committed to malaria elimination when the transmission was thought to be low, but before robust national parasite prevalence estimates were available. In 2011, the first national population-based survey confirmed the national malaria parasite prevalence was < 1%. In both 2014 and 2015, Haiti reported approximately 17,000 malaria cases identified passively at health facilities. To detect malaria transmission hotspots for targeting interventions, the National Malaria Control Program (NMCP) piloted an enhanced geographic information surveillance system in three departments with relatively high-, medium-, and low-transmission areas. From October 2014–September 2015, NMCP staff abstracted health facility records of confirmed malaria cases from 59 health facilities and geo-located patients’ households. Household locations were aggregated to 1-km2 grid cells to calculate cumulative incidence rates (CIRs) per 1,000 persons. Spatial clustering of CIRs were tested using Getis-Ord Gi* analysis. Space–time permutation models searched for clusters up to 6 km in distance using a 1-month malaria transmission window. Of the 2,462 confirmed cases identified from health facility records, 58% were geo-located. Getis-Ord Gi* analysis identified 43 1-km2 hotspots in coastal and inland areas that overlapped primarily with 13 space–time clusters (size: 0.26–2.97 km). This pilot describes the feasibility of detecting malaria hotspots in resource-poor settings. More data from multiple years and serological household surveys are needed to assess completeness and hotspot stability. The NMCP can use these pilot methods and results to target foci investigations and malaria interventions more accurately.

Author Notes

Address correspondence to Amber M. Dismer, Atlanta, GA. E-mail: adismer@cdc.gov

Disclaimer: The conclusions, findings, and opinions expressed by the authors do not necessarily reflect the official position of the U.S. CDC.

Financial support: This project was funded by the CDC through a cooperative agreement with the Ministry of Public Health and Population. CDC contributors provided in-kind support through technical assistance, analysis, field supervision, and manuscript writing.

Authors’ addresses: Amber M. Dismer, U.S. Centers for Disease Control and Prevention, Division of Global Health Protection, Atlanta, GA, E-mail: adismer@cdc.gov. Jean Frantz Lemoine and Mérilien Jean Baptiste, Haiti’s Ministry of Public Health and Population, National Malaria Control Program, Port-au-Prince, Haiti, E-mails: tileum@hotmail.com and ingmjb6@gmail.com. Kimberly E. Mace, Daniel Impoinvil, Jodi Vanden Eng, and Michelle A. Chang, U.S. Centers for Disease Control and Prevention, Division of Parasitic Diseases and Malaria, Atlanta, GA, E-mails: igd3@cdc.gov, xda6@cdc.gov, jodi.vandeneng@gmail.com, and aup6@cdc.gov.

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