From Control to Elimination: A Spatial-Temporal Analysis of Malaria Along the China-Myanmar Border

Abstract

Background: Malaria cases have declined significantly along the China-Myanmar border in the past 10 years and this region is going through a process from control to elimination. The aim of this study is to investigate the epidemiology of malaria along the border, will identify challenges in the progress from control to elimination. Methods: National reported malaria cases from China and Myanmar, along with the data of 18 Chinese border counties and 23 townships in Myanmar were obtained from a web-based diseases information reporting system in China and the national malaria control program of Myanmar, respectively. Epidemiological data was analyzed, including the number of reported cases, annual parasite index and proportion of vivax infection. Spatial mapping of the API at county or township level in 2014 and 2018 was performed by ArcGIS. The relationship of malaria endemicity on both sides of the border was evaluated by regression analysis. Results: The number of reported malaria cases and API declined in the border counties or townships. In 2014, 392 malaria cases were reported from 18 Chinese border counties, including 8.42% indigenous cases and 91.58%% imported cases, while the highest API (0.11) was occurred in Yingjiang County. There have been no indigenous cases reported since 2017, but 164 imported cases were reported in 2018 and 97.56% were imported from Myanmar. The average API in 2014 in 23 Myanmar townships was significantly greater than that of 18 Chinese counties (P<0.01). However, the API decreased significantly in Myanmar side from 2014 to 2018 (P<0.01). The number of townships with an API between 0~1 increased to 15 in 2018, compared to only five in 2014, while still four townships had API>10. Plasmodium vivax was the predominant species along the border. The number of reported malaria cases and the proportion of vivax infection in the 18 Chinese counties were strongly correlated with those of the 23 Myanmar townships (P<0.05).Conclusions: Malaria elimination is approaching along the China-Myanmar border. However, in order to achieve the malaria elimination in this region and prevent the re-establishment of malaria in China after elimination, continued political, financial and scientific commitment is required.

Spatio-temporal trend of malaria incidence from 2011 to 2017 and environmental predictors of malaria transmission in Myanmar

“…In the last three years of the study period, P. vivax clustered in eastern Kachin State bordering China and southern Shan State and Kayah State bordering Thailand. Previous studies showed P. vivax is the predominant species along many of these international borders [25,47,48].…”

Malaria in Angola: recent progress, challenges and future opportunities using parasite demography studies

“…These challenges have led to the emergence of geographically-based initiatives to tackle malaria in border regions [23,[101][102][103]. The Elimination Eight Initiative (E8) (https:// malar iaeli minat ion8.…”

“…5) [104]. The E8 is pioneering an ambitious regionally-based strategy including cross-border initiatives to roll back malaria from the southernmost countries, including Angola, and accelerate collective progress towards zero transmission [103,104]. As part of E8 initiatives, eight border malaria health posts and surveillance teams were deployed to the border areas of the provinces of Cuando Cubango and Cunene, where "Test, Treat and Track" (TTT) measures were implemented, providing access to malaria diagnosis and treatment services, specifically targeting two key populations at risk of malaria, namely underserved residents of border districts, and mobile and migrant populations.…”