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Sci Rep. 2017 Aug 14;7(1):8082. doi: 10.1038/s41598-017-07818-0.

Micro-epidemiology and spatial heterogeneity of P. vivax parasitaemia in riverine communities of the Peruvian Amazon: A multilevel analysis.

Author information

1
Laboratorio ICEMR-Amazonia, Laboratorios de Investigacióny Desarrollo, Facultad de Cienciasy Filosofia, Universidad Peruana Cayetano Heredia, Lima, Peru. Gabriel.carrasco@upch.pe.
2
Facultad de Salud Públicay Administración, Universidad Peruana Cayetano Heredia, Lima, Peru. Gabriel.carrasco@upch.pe.
3
Laboratorio ICEMR-Amazonia, Laboratorios de Investigacióny Desarrollo, Facultad de Cienciasy Filosofia, Universidad Peruana Cayetano Heredia, Lima, Peru.
4
Instituto de Medicina Tropical "Alexander von Humboldt", Universidad Peruana Cayetano Heredia, Lima, Peru.
5
Departamento de Ciencias Celularesy Moleculares, Facultad de Ciencias y Filosofia, Universidad Peruana Cayetano Heredia, Lima, Peru.
6
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
7
Department of Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
8
Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
9
Región de Salud Loreto, Iquitos, Loreto, Peru.
10
Research Institute of Health and Society (IRSS), Université Catholique de Louvain, Brussels, Belgium.
11
Facultad de Salud Públicay Administración, Universidad Peruana Cayetano Heredia, Lima, Peru.
12
Division of Infectious Diseases, Department of Medicine, University of California San Diego School of Medicine, La Jolla, California, USA.
13
Facultad de Salud Públicay Administración, Universidad Peruana Cayetano Heredia, Lima, Peru. alejandro.llanos.c@upch.pe.
14
Instituto de Medicina Tropical "Alexander von Humboldt", Universidad Peruana Cayetano Heredia, Lima, Peru. alejandro.llanos.c@upch.pe.

Abstract

Malaria has steadily increased in the Peruvian Amazon over the last five years. This study aimed to determine the parasite prevalence and micro-geographical heterogeneity of Plasmodium vivax parasitaemia in communities of the Peruvian Amazon. Four cross-sectional active case detection surveys were conducted between May and July 2015 in four riverine communities in Mazan district. Analysis of 2785 samples of 820 individuals nested within 154 households for Plasmodium parasitaemia was carried out using light microscopy and qPCR. The spatio-temporal distribution of Plasmodium parasitaemia, dominated by P. vivax, was shown to cluster at both household and community levels. Of enrolled individuals, 47% had at least one P. vivax parasitaemia and 10% P. falciparum, by qPCR, both of which were predominantly sub-microscopic and asymptomatic. Spatial analysis detected significant clustering in three communities. Our findings showed that communities at small-to-moderate spatial scales differed in P. vivax parasite prevalence, and multilevel Poisson regression models showed that such differences were influenced by factors such as age, education, and location of households within high-risk clusters, as well as factors linked to a local micro-geographic context, such as travel and occupation. Complex transmission patterns were found to be related to human mobility among communities in the same micro-basin.

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