Spatial analysis to evaluate risk of malaria in Northern Sumatera, Indonesia

Abstract

Background: As Indonesia aims for malaria elimination by 2030, provisional malaria epidemiology and risk factors evaluation are important in pursue of this national goal. Therefore, this study aimed to understand the risk factor of malaria in Northern Sumatera. Methods: Malaria cases from 2019 to 2020 were obtained from the Indonesian Ministry of Health Electronic Database. Climatic variables were provided by the Center for Meteorology and Geophysics Medan branch ofce. Multivariable logistic regression was undertaken to understand the risk factors of imported malaria. A zero-infated Poisson multivariable regression model was used to study the climatic drivers of indigenous malaria. Results: A total of 2208 (indigenous: 76.0% [1679] and imported: 17.8% [392]) were reported during the study period. Risk factors of imported malaria were: ages 19–30 (adjusted odds ratio [AOR]=3.31; 95% confdence interval [CI] 1.67, 2.56), 31–45 (AOR=5.69; 95% CI 2.65, 12.20), and>45 years (AOR=5.11; 95% CI 2.41, 10.84). Military personnel and forest workers and miners were 1,154 times (AOR=197.03; 95% CI 145.93, 9,131.56) and 44 times (AOR=44.16; 95% CI 4.08, 477,93) more likely to be imported cases as compared to those working as employees and traders. Indigenous Plasmodium falciparum increased by 12.1% (95% CrI 5.1%, 20.1%) for 1% increase in relative humidity and by 21.0% (95% CrI 9.0%, 36.2%) for 1 °C increase in maximum temperature. Plasmodium vivax decreased by 0.8% (95% CrI 0.2%, 1.3%) and 16.7% (95% CrI 13.7%, 19.9%) for one meter and 1 °C increase of altitude and minimum temperature. Indigenous hotspot was reported by Kota Tanjung Balai city and Asahan regency, respectively. Imported malaria hotspots were reported in Batu Bara, Kota Tebing Tinggi, Serdang Bedagai and Simalungun. Conclusion: Both indigenous and imported malaria is limited to a few regencies and cities in Northern Sumatera. The control measures should focus on these risk factors to achieve elimination in Indonesia