Int J Health Geogr - Spatial-explicit modeling of social vulnerability to malaria in East Africa.


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CKGROUND: Despite efforts in eradication and control, malaria remains a global challenge, particularly affecting vulnerable groups. Despite the recession in malaria cases, previously malaria free areas are increasingly confronted with epidemics as a result of changing environmental and socioeconomic conditions. Next to modeling transmission intensities and probabilities, integrated spatial methods targeting the complex interplay of factors that contribute to social vulnerability are required to effectively reduce malaria burden. We propose an integrative method for mapping relative levels of social vulnerability in a spatially explicit manner to support the identification of intervention measures.METHODS: Based on a literature review, a holistic risk and vulnerability framework has been developed to guide the assessment of social vulnerability to water-related vector-borne diseases (VBDs) in the context of changing environmental and societal conditions. Building on the framework, this paper applies spatially explicit modeling for delineating homogeneous regions of social vulnerability to malaria in eastern Africa, while taking into account expert knowledge for weighting the single vulnerability indicators. To assess the influence of the selected indicators on the final index a local sensitivity analysis is carried out.RESULTS: Results indicate that high levels of malaria vulnerability are concentrated in the highlands, where immunity within the population is currently low. Additionally, regions with a lack of access to education and health services aggravate vulnerability. Lower values can be found in regions with relatively low poverty, low population pressure, low conflict density and reduced contributions from the biological susceptibility domain. Overall, the factors characterizing vulnerability vary spatially in the region. The vulnerability index reveals a high level of robustness in regard to the final choice of input datasets, with the exception of the immunity indicator which has a marked impact on the composite vulnerability index.CONCLUSIONS: We introduce a conceptual framework for modeling risk and vulnerability to VBDs. Drawing on the framework we modeled social vulnerability to malaria in the context of global change using a spatially explicit approach. The results provide decision makers with place-specific options for targeting interventions that aim at reducing the burden of the disease amongst the different vulnerable population groups.

Resumo Limpo

ckground despit effort erad control malaria remain global challeng particular affect vulner group despit recess malaria case previous malaria free area increas confront epidem result chang environment socioeconom condit next model transmiss intens probabl integr spatial method target complex interplay factor contribut social vulner requir effect reduc malaria burden propos integr method map relat level social vulner spatial explicit manner support identif intervent measuresmethod base literatur review holist risk vulner framework develop guid assess social vulner waterrel vectorborn diseas vbds context chang environment societ condit build framework paper appli spatial explicit model delin homogen region social vulner malaria eastern africa take account expert knowledg weight singl vulner indic assess influenc select indic final index local sensit analysi carri outresult result indic high level malaria vulner concentr highland immun within popul current low addit region lack access educ health servic aggrav vulner lower valu can found region relat low poverti low popul pressur low conflict densiti reduc contribut biolog suscept domain overal factor character vulner vari spatial region vulner index reveal high level robust regard final choic input dataset except immun indic mark impact composit vulner indexconclus introduc conceptu framework model risk vulner vbds draw framework model social vulner malaria context global chang use spatial explicit approach result provid decis maker placespecif option target intervent aim reduc burden diseas amongst differ vulner popul group

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