Ranking of elimination feasibility between malaria-endemic countries.
Bottom Line: Spatial data for these factors were assembled for all malaria-endemic countries and combined to provide an objective, relative ranking of countries by technical, operational, and combined elimination feasibility.The analysis was done separately for Plasmodium falciparum and Plasmodium vivax, and the limitations of the approach were discussed.The results differed when feasibility was measured by technical or operational factors, highlighting the different types of challenge faced by each country.
Affiliation: Department of Geography, University of Florida, Gainesville, FL 32610, USA. atatem@ufl .eduShow MeSH
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Mentions: Mean rankings for relative technical feasibility are shown in table 2 and figure 2. Additional outputs are presented in webappendix p 30. The combination of low population-weighted R0 and low levels of movement from other countries endemic for P falciparum malaria result in Belize, Suriname, and Bolivia being ranked as more technically feasible for P falciparum elimination relative to the other P falciparum malaria-endemic countries. By contrast, because of widespread high endemic transmission intensities and substantial incoming movement from surrounding west African countries with high levels of transmission, Côte d'Ivoire, Burkina Faso, and Nigeria are the least technically feasible candidates for elimination. Figure 3 shows that our estimates for relative technical feasibility resemble current patterns of P falciparum transmission intensity,12 with more countries in the Americas and Asia showing a lower average ranking than those in sub-Saharan Africa. Exceptions to the rule are related to patterns of human movement. For example, although transmission of P falciparum in Thailand is relatively low overall, high levels of movement from surrounding countries with higher transmission increase its malaria importation rate relative to other countries. This situation reduces the estimates of overall relative technical feasibility of P falciparum elimination to an average ranking that is similar to that of islands such as Madagascar and São Tomé and Príncipe, which have higher levels of baseline transmission but much lower rates of P falciparum importation than does Thailand.
Affiliation: Department of Geography, University of Florida, Gainesville, FL 32610, USA. atatem@ufl .edu