{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T10:48:03Z","timestamp":1772621283276,"version":"3.50.1"},"update-to":[{"DOI":"10.1371\/journal.pcbi.1008669","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2021,3,11]],"date-time":"2021-03-11T00:00:00Z","timestamp":1615420800000}}],"reference-count":61,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2021,3,1]],"date-time":"2021-03-01T00:00:00Z","timestamp":1614556800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"NA"}],"content-domain":{"domain":["www.ploscompbiol.org"],"crossmark-restriction":false},"short-container-title":["PLoS Comput Biol"],"abstract":"<jats:p>While mortality from malaria continues to decline globally, incidence rates in many countries are rising. Within countries, spatial and temporal patterns of malaria vary across communities due to many different physical and social environmental factors. To identify those areas most suitable for malaria elimination or targeted control interventions, we used Bayesian models to estimate the spatiotemporal variation of malaria risk, rates, and trends to determine areas of high or low malaria burden compared to their geographical neighbours. We present a methodology using Bayesian hierarchical models with a Markov Chain Monte Carlo (MCMC) based inference to fit a generalised linear mixed model with a conditional autoregressive structure. We modelled clusters of similar spatiotemporal trends in malaria risk, using trend functions with constrained shapes and visualised high and low burden districts using a multi-criterion index derived by combining spatiotemporal risk, rates and trends of districts in Zambia. Our results indicate that over 3 million people in Zambia live in high-burden districts with either high mortality burden or high incidence burden coupled with an increasing trend over 16 years (2000 to 2015) for all age, under-five and over-five cohorts. Approximately 1.6 million people live in high-incidence burden areas alone. Using our method, we have developed a platform that can enable malaria programs in countries like Zambia to target those high-burden areas with intensive control measures while at the same time pursue malaria elimination efforts in all other areas. Our method enhances conventional approaches and measures to identify those districts which had higher rates and increasing trends and risk. This study provides a method and a means that can help policy makers evaluate intervention impact over time and adopt appropriate geographically targeted strategies that address the issues of both high-burden areas, through intensive control approaches, and low-burden areas, via specific elimination programs.<\/jats:p>","DOI":"10.1371\/journal.pcbi.1008669","type":"journal-article","created":{"date-parts":[[2021,3,1]],"date-time":"2021-03-01T18:34:36Z","timestamp":1614623676000},"page":"e1008669","update-policy":"https:\/\/doi.org\/10.1371\/journal.pcbi.corrections_policy","source":"Crossref","is-referenced-by-count":14,"title":["Modelling of malaria risk, rates, and trends: A spatiotemporal approach for identifying and targeting sub-national areas of high and low burden"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9570-9036","authenticated-orcid":true,"given":"Jailos","family":"Lubinda","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0979-4084","authenticated-orcid":true,"given":"Yaxin","family":"Bi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Busiku","family":"Hamainza","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7413-1017","authenticated-orcid":true,"given":"Ubydul","family":"Haque","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9313-909X","authenticated-orcid":true,"given":"Adrian J.","family":"Moore","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,3,1]]},"reference":[{"key":"pcbi.1008669.ref001","unstructured":"World Health Organization. World Malaria Report 2018 [Internet]. World Health Organization: Geneva; 2018. Available from: https:\/\/www.who.int\/malaria\/media\/world-malaria-report-2018\/en\/."},{"key":"pcbi.1008669.ref002","unstructured":"World Health Organization. World Malaria Report 2017. World Health Organization: Geneva; 2017."},{"key":"pcbi.1008669.ref003","first-page":"1","volume-title":"Lancet","author":"P Alonso","year":"2017"},{"key":"pcbi.1008669.ref004","first-page":"1","author":"World Health Organization","year":"2018","journal-title":"RBM. High burden to high impact A targeted malaria response advance copy"},{"key":"pcbi.1008669.ref005","first-page":"2246","volume-title":"Lancet","author":"TA Ghebreyesus","year":"2018"},{"key":"pcbi.1008669.ref006","first-page":"1","author":"National Malaria Elimination Programme","year":"2017","journal-title":"National Malaria Elimination Strategic Plan 2017\u20132021: Moving from accelerated burden reduction to malaria elimination in Zambia"},{"key":"pcbi.1008669.ref007","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1475-2875-12-437","article-title":"The changing burden of malaria and association with vector control interventions in Zambia using district-level surveillance data, 2006\u20132011","volume":"12","author":"M Kamuliwo","year":"2013","journal-title":"Malar J"},{"key":"pcbi.1008669.ref008","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/S2221-1691(13)60030-1","article-title":"Review of the malaria epidemiology and trends in Zambia","volume":"3","author":"F Masaninga","year":"2013","journal-title":"Asian Pac J Trop Biomed."},{"key":"pcbi.1008669.ref009","doi-asserted-by":"crossref","first-page":"480","DOI":"10.4269\/ajtmh.2010.10-0035","article-title":"Scaling up malaria control in Zambia: Progress and impact 2005\u20132008","volume":"83","author":"E Chizema-Kawesha","year":"2010","journal-title":"Am J Trop Med Hyg."},{"key":"pcbi.1008669.ref010","author":"National Malaria Control Programme","year":"2012","journal-title":"National Malaria Control Programme Strategic Plan For FY 2011\u20132015"},{"key":"pcbi.1008669.ref011","first-page":"1","article-title":"Exploring the use of routinely-available, retrospective data to study the association between malaria control scale-up and micro-economic outcomes in Zambia","volume":"16","author":"A Comfort","year":"2017","journal-title":"Malar J. BioMed Central"},{"key":"pcbi.1008669.ref012","author":"E8 Secretariate","year":"2018","journal-title":"State of Malaria in the E8"},{"key":"pcbi.1008669.ref013","author":"President\u2019s Malaria Initiative (PMI)","year":"2017","journal-title":"Malaria Operational Plan FY 2017 -Zambia"},{"key":"pcbi.1008669.ref014","author":"Zambia National Malaria Elimination Centre","year":"2017","journal-title":"National Malaria Elimination Strategic Plan 2017\u20132021: Moving from accelerated burden reduction to malaria elimination in Zambia"},{"key":"pcbi.1008669.ref015","first-page":"302","volume-title":"Bull World Health Organ","author":"S Loewenberg","year":"2018"},{"key":"pcbi.1008669.ref016","first-page":"e1695","volume-title":"Lancet Glob Heal","author":"C Kitojo","year":"2019"},{"key":"pcbi.1008669.ref017","first-page":"628842","volume-title":"bioRxiv","author":"I Routledge","year":"2019"},{"key":"pcbi.1008669.ref018","volume-title":"ASTMH 68th Annu Meet","author":"E Amratia","year":"2019"},{"key":"pcbi.1008669.ref019","first-page":"199","author":"Central Statistical Office","year":"2013","journal-title":"2010 census of population and housing: Population and Demographic Projections 2011\u20132035"},{"key":"pcbi.1008669.ref020","author":"Elimination8 Secretariat","year":"2017","journal-title":"Working towards a malaria-free Southern Africa"},{"key":"pcbi.1008669.ref021","unstructured":"Central Statistical Office. 2010 Zambia Census of Population and Housing: Summary Report. 2012;"},{"key":"pcbi.1008669.ref022","first-page":"413","volume-title":"Lancet.","author":"CJL Murray","year":"2012"},{"key":"pcbi.1008669.ref023","unstructured":"World Health Organization. World Malaria Report 2008. World Health Organization: Geneva; 2008."},{"key":"pcbi.1008669.ref024","unstructured":"World Health Organization. World Malaria Report 2011. World Health Organization: Geneva; 2011."},{"key":"pcbi.1008669.ref025","doi-asserted-by":"crossref","first-page":"437","DOI":"10.4269\/ajtmh.2012.12-0127","article-title":"Reductions in artemisinin-based combination therapy consumption after the nationwide scale up of routine malaria rapid diagnostic testing in Zambia","volume":"87","author":"JO Yukich","year":"2012","journal-title":"Am J Trop Med Hyg."},{"key":"pcbi.1008669.ref026","doi-asserted-by":"crossref","first-page":"495037","DOI":"10.5402\/2013\/495037","article-title":"An overview of the malaria control programme in Zambia","volume":"2013","author":"E Chanda","year":"2013","journal-title":"ISRN Prev Med"},{"key":"pcbi.1008669.ref027","doi-asserted-by":"crossref","first-page":"45","DOI":"10.4269\/ajtmh.2008.79.45","article-title":"National malaria control and scaling up for impact: The Zambia experience through 2006","volume":"79","author":"RW Steketee","year":"2008","journal-title":"Am J Trop Med Hyg."},{"key":"pcbi.1008669.ref028","doi-asserted-by":"crossref","first-page":"330","DOI":"10.4081\/gh.2015.330","article-title":"Diagnostic approaches to malaria in Zambia, 2009\u20132014","volume":"10","author":"V Mukonka","year":"2015","journal-title":"Geospat Health."},{"key":"pcbi.1008669.ref029","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1186\/1475-2875-11-170","article-title":"Characterizing the spatial and temporal variation of malaria incidence in Bangladesh, 2007","volume":"11","author":"HL Reid","year":"2012","journal-title":"Malar J"},{"key":"pcbi.1008669.ref030","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/1476-072X-5-20","article-title":"Spatio-temporal analysis of the role of climate in inter-annual variation of malaria incidence in Zimbabwe","volume":"5","author":"MLH Mabaso","year":"2006","journal-title":"Int J Health Geogr"},{"key":"pcbi.1008669.ref031","first-page":"166","article-title":"Determinants of the spatial and temporal distribution of malaria in Zambia and association with vector control","author":"A Bennett","year":"2012","journal-title":"ProQuest Diss Theses"},{"key":"pcbi.1008669.ref032","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1093\/ije\/dyt043","article-title":"Markov chain monte carlo: An introduction for epidemiologists","volume":"42","author":"G Hamra","year":"2013","journal-title":"Int J Epidemiol."},{"key":"pcbi.1008669.ref033","article-title":"Spatio-Temporal Areal Unit Modeling in R with Conditional Autoregressive Priors Using the CARBayesST Package","volume":"84","author":"D Lee","year":"2018","journal-title":"J Stat Softw"},{"key":"pcbi.1008669.ref034","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1093\/biostatistics\/kxr043","article-title":"Classification method for disease risk mapping based on discrete hidden Markov random fields","volume":"13","author":"M Charras-Garrido","year":"2012","journal-title":"Biostatistics"},{"key":"pcbi.1008669.ref035","first-page":"1","article-title":"A Bayesian space-time model for clustering areal units based on their disease trends","volume":"00","author":"G Napier","year":"2018","journal-title":"Biostatistics"},{"key":"pcbi.1008669.ref036","volume-title":"R: A Language and Environment for Statistical Computing","author":"R Core Team","year":"2013"},{"key":"pcbi.1008669.ref037","volume-title":"R: A language and environment for statistical computing","author":"R Core Team. R Core Team","year":"2018"},{"key":"pcbi.1008669.ref038","first-page":"1185","volume-title":"Stat Methods Med Res","author":"G Napier","year":"2016"},{"key":"pcbi.1008669.ref039","unstructured":"World Bank. Zambia Study Shows Stronger Supply Chains for Key Drugs Can Reduce Child Mortality. Washington, DC; 2010."},{"key":"pcbi.1008669.ref040","unstructured":"Zambia Ministry of Health Logistics Pilot Program Steering Committee. Essential Medicines Logistics Pilot Program: Steering Committee Evaluation Report. Lusaka; 2011."},{"key":"pcbi.1008669.ref041","volume-title":"Wiley Encycl Oper Res Manag Sci","author":"P Yadav","year":"2010"},{"key":"pcbi.1008669.ref042","first-page":"e0156026","volume-title":"PLoS One","author":"N-HZ Leung","year":"2016"},{"key":"pcbi.1008669.ref043","unstructured":"USAID | Deliver Project TO 4 and 7. USAID | Deliver Project Final Country Report: Zambia. Arlington; 2016."},{"key":"pcbi.1008669.ref044","author":"President\u2019s Malaria Initiative","year":"2019","journal-title":"President\u2019s Malaria Initiative Zambia Malaria Operational Plan FY 2019"},{"key":"pcbi.1008669.ref045","first-page":"158","volume-title":"Heal Syst Reform","author":"M Vledder","year":"2019"},{"key":"pcbi.1008669.ref046","first-page":"1436","volume-title":"Lancet.","author":"M Pinder","year":"2015"},{"key":"pcbi.1008669.ref047","first-page":"458","article-title":"Malaria control in Botswana, 2008\u20132012: the path towards elimination","volume":"12","author":"C Simon","year":"2013","journal-title":"Malar J. BioMed Central"},{"key":"pcbi.1008669.ref048","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1186\/s13071-016-1382-z","article-title":"Malaria elimination in Botswana, 2012\u20132014: achievements and challenges","volume":"9","author":"S Chihanga","year":"2016","journal-title":"Parasit Vectors. BioMed Central"},{"key":"pcbi.1008669.ref049","first-page":"156","article-title":"Progress and challenges to control malaria in a remote area of Chittagong hill tracts, Bangladesh","volume":"9","author":"U Haque","year":"2010","journal-title":"Malar J. BioMed Central"},{"key":"pcbi.1008669.ref050","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1186\/s13071-016-1693-0","article-title":"The relative contribution of climate variability and vector control coverage to changes in malaria parasite prevalence in Zambia 2006\u20132012. Parasit Vectors","volume":"9","author":"A Bennett","year":"2016","journal-title":"Parasites & Vectors"},{"key":"pcbi.1008669.ref051","author":"Zambia Ministry of Health","year":"2019","journal-title":"Zambia Malaria Indicator Survey\u2014MIS 2018"},{"key":"pcbi.1008669.ref052","unstructured":"Zambian Ministry of Health. The 2012 List of Health Facilities in Zambia: Preliminary Report, v15. Ministry of Health Lusaka; 2013."},{"key":"pcbi.1008669.ref053","article-title":"The human resource for health situation in Zambia: Deficit and maldistribution","author":"P Ferrinho","year":"2011","journal-title":"Hum Resour Health."},{"key":"pcbi.1008669.ref054","article-title":"Current access to health information in Zambia: A survey of selected health institutions","author":"J Hoppenbrouwer","year":"2007","journal-title":"Health Info Libr J."},{"key":"pcbi.1008669.ref055","unstructured":"CSO. 2010 Census of population and housing: National Analytical Report. Natl Anal Rep. 2012;"},{"key":"pcbi.1008669.ref056","first-page":"38","author":"Zambian Ministry of Health","year":"2006","journal-title":"Zambia National Malaria Indicator Survey 2006"},{"key":"pcbi.1008669.ref057","author":"Zambian Ministry of Health","year":"2008","journal-title":"The Zambia National Malaria Indicator Survey 2008"},{"key":"pcbi.1008669.ref058","author":"Zambian Ministry of Health","year":"2015","journal-title":"Zambia Malaria Indicator Survey 2015"},{"key":"pcbi.1008669.ref059","author":"Zambian Ministry of Health","year":"2012","journal-title":"Zambia National Malaria Indicator Survey 2012"},{"key":"pcbi.1008669.ref060","article-title":"Zambia National Malaria Indicator Survey 2010","author":"Zambian Ministry of Health","year":"2010"},{"key":"pcbi.1008669.ref061","first-page":"1","volume-title":"Sci Rep.","author":"J Lubinda","year":"2021"}],"updated-by":[{"DOI":"10.1371\/journal.pcbi.1008669","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2021,3,11]],"date-time":"2021-03-11T00:00:00Z","timestamp":1615420800000}}],"container-title":["PLOS Computational Biology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pcbi.1008669","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,3,11]],"date-time":"2021-03-11T18:59:30Z","timestamp":1615489170000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pcbi.1008669"}},"subtitle":[],"editor":[{"given":"Jane M.","family":"Heffernan","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2021,3,1]]},"references-count":61,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2021,3,1]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pcbi.1008669","relation":{"new_version":[{"id-type":"doi","id":"10.1371\/journal.pcbi.1008669","asserted-by":"object"}]},"ISSN":["1553-7358"],"issn-type":[{"value":"1553-7358","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,1]]}}}