{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T15:38:31Z","timestamp":1766158711116,"version":"build-2065373602"},"reference-count":32,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2021,5,22]],"date-time":"2021-05-22T00:00:00Z","timestamp":1621641600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Malaria in Bhutan has fallen significantly over the last decade. As Bhutan attempts to eliminate malaria in 2022, this study aimed to characterize the space\u2013time clustering of malaria from 2010 to 2019. Malaria data were obtained from the Bhutan Vector-Borne Disease Control Program data repository. Spatial and space\u2013time cluster analyses of Plasmodium falciparum and Plasmodium vivax cases were conducted at the sub-district level from 2010 to 2019 using Kulldorff\u2019s space\u2013time scan statistic. A total of 768 confirmed malaria cases, including 454 (59%) P. vivax cases, were reported in Bhutan during the study period. Significant temporal clusters of cases caused by both species were identified between April and September. The most likely spatial clusters were detected in the central part of Bhutan throughout the study period. The most likely space\u2013time cluster was in Sarpang District and neighboring districts between January 2010 to June 2012 for cases of infection with both species. The most likely cluster for P. falciparum infection had a radius of 50.4 km and included 26 sub-districts with a relative risk (RR) of 32.7. The most likely cluster for P. vivax infection had a radius of 33.6 km with 11 sub-districts and RR of 27.7. Three secondary space\u2013time clusters were detected in other parts of Bhutan. Spatial and space\u2013time cluster analysis identified high-risk areas and periods for both P. vivax and P. falciparum malaria. Both malaria types showed significant spatial and spatiotemporal variations. Operational research to understand the drivers of residual transmission in hotspot sub-districts will help to overcome the final challenges of malaria elimination in Bhutan.<\/jats:p>","DOI":"10.3390\/ijerph18115553","type":"journal-article","created":{"date-parts":[[2021,5,23]],"date-time":"2021-05-23T23:58:05Z","timestamp":1621814285000},"page":"5553","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Space\u2013Time Clustering Characteristics of Malaria in Bhutan at the End Stages of Elimination"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8857-2665","authenticated-orcid":false,"given":"Kinley","family":"Wangdi","sequence":"first","affiliation":[{"name":"Research School of Population Health, Australian National University, Canberra, ACT 2601, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9529-4096","authenticated-orcid":false,"given":"Kinley","family":"Penjor","sequence":"additional","affiliation":[{"name":"Vector-Borne Diseases Control Program, Department of Public Health, Ministry of Health, Gelephu 31101, Bhutan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"family":"Tobgyal","sequence":"additional","affiliation":[{"name":"Vector-Borne Diseases Control Program, Department of Public Health, Ministry of Health, Gelephu 31101, Bhutan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4841-7924","authenticated-orcid":false,"given":"Saranath","family":"Lawpoolsri","sequence":"additional","affiliation":[{"name":"Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2000-2874","authenticated-orcid":false,"given":"Ric N.","family":"Price","sequence":"additional","affiliation":[{"name":"Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia"},{"name":"Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford OX1 2JD, UK"},{"name":"Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter W.","family":"Gething","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Curtin University, Bentley, WA 6102, Australia"},{"name":"Telethon Kids Institute, Nedlands, WA 6009, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Darren J.","family":"Gray","sequence":"additional","affiliation":[{"name":"Research School of Population Health, Australian National University, Canberra, ACT 2601, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6612-3981","authenticated-orcid":false,"given":"Elivelton","family":"Da Silva Fonseca","sequence":"additional","affiliation":[{"name":"Institute of Geography, Federal University of Uberl\u00e2ndia, Uberl\u00e2ndia, MG 38408-100, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Archie C. A.","family":"Clements","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Curtin University, Bentley, WA 6102, Australia"},{"name":"Telethon Kids Institute, Nedlands, WA 6009, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,5,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1186\/1475-2875-10-89","article-title":"Spatio-temporal patterns of malaria infection in Bhutan: A country embarking on malaria elimination","volume":"10","author":"Wangdi","year":"2011","journal-title":"Malar. J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e336","DOI":"10.1016\/S2214-109X(16)00083-8","article-title":"Malaria burden and costs of intensified control in Bhutan, 2006\u20132014: An observational study and situation analysis","volume":"4","author":"Wangdi","year":"2016","journal-title":"Lancet Glob. 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