Epidemiological Profile of Malaria in a Rural Community From the Amazon of Mato Grosso

Epidemiological Profile of Malaria in a Rural Community From the Amazon of Mato Grosso | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Epidemiological Profile of Malaria in a Rural Community From the Amazon of Mato Grosso Elaine Cristina De Oliveira, Emerson Soares dos Santos, Paulo Antonio Ferreira Junior, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2749203/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 05 Aug, 2024 Read the published version in Malaria Journal → Version 1 posted 7 You are reading this latest preprint version Abstract More than 95% of malaria transmission in Brazil occurs in the region called Legal Amazon constituted among other Brazilian states, including Mato Grosso, where, in 2015, 54% of the cases occurred in the municipality of Colniza, in the northwestern region of the state. Objetive: To describe the epidemiological profile of malaria in a rural community in the northwestern region of Mato Grosso, emphasizing its spatial pattern of occurrence. Methods: This is an ecological study covering information on the prevalence of plasmodium infection and on the use and occupation of soil by the population of the Três Fronteiras District, in the municipality of Colniza, Mato Grosso. Data were collected through a home visit in July 2011, with blood collection from the digital pulp for the preparation of a thick smear slide, completion of the SIVEP_Malaria notification form, for the construction of a georeferenced database with the software ArcGIS 9.2 (ESRI Corp.). The information was divided into use and occupation classes. In TerraView 3.14, a Kernel map was built to verify the density of cases and their location. Results: Of the 621 respondents, 68(11%) had plasmodium infection, 39(57.4%) of them by P. vivax, 27(39.7%) by P. falciparum and two (2.9%) with mixed infection. Among infected individuals, 49(72.1%) were men and 19(27.9%), women. The distribution of prevalent cases of infection by overlaying the map of occupation and use of land showed that the cases of malaria are distributed over the entire length of the district, with greater occurrence of cases per household in open areas, close to the mining company/artisanal mining. The kernel method, from the characterization of the spatial distribution pattern of malaria cases, allowed identifying areas of greater intensity of cases, whose so-called “hot” areas were located in the gold mining region. Conclusion: The transmission of malaria in the district of Três Fronteiras has a heterogeneous profile along its length, and the individuals residing in areas of mining, artisanal mining and timber extraction has increased frequency of infection by plasmodium, and its spatial pattern has a difference in the intensity of distribution of the disease. malaria spatial analysis epidemiology Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Malaria is considered a serious public health problem worldwide, being responsible for the greatest increase in morbidity and mortality in countries with tropical and subtropical climates. Caused by protozoa of the Plasmodium genus , the female Anopheles is responsible for transmitting the disease (WHO, 2018). According to the World Health Organization, around 241 million cases of malaria were reported in 2020 in 85 endemic countries, 6.2% higher than the 2019 data (227 million). Estimates show that 3.4 billion people are at risk of malaria worldwide (WHO, 2022). It accounts for 99% of the cases of this infection of autochthonous origin in the regions known as Amazônia Legal, which includes the states of Acre, Amapá, Amazonas, Maranhão, Mato Grosso, Rondônia, Roraima and Tocantins, comprising 807 municipalities of different territorial extensions and population sizes. (FIOCRUZ, 2019). Although its incidence is decreasing with about 8% (18.5 million) in 2000, to 2% (4.5 million) in 2020, the number of deaths from malaria in a period from 2000 (896,000) to 2019 (558,000) there was a reduction of about 60.6% however when comparing the year 2019 with 2020, there is an increase of 12% (627. 000) in the number of deaths, this is due to the fact that in this period occurred the emergence of the pandemic of COVID-19 and consequently with the social isolation and the interruptions of various health services, favored for this growth (WHO, 2021). The state of Mato Grosso, although hyperendemic for malaria in the 1980’s and the beginning of the 1990’s, has been presenting significant reduction of transmission in recent years. The comparison between the numbers recorded in 2011 and 2000 shows a reduction of 86.1% in the number of cases of the disease. This proportional reduction ranked Mato Grosso as the state of Legal Amazon that contributed the most for the control of malaria in Brazil, in this new millennium (BRAZIL, 2013). Despite its heterogeneous geographical distribution until 2003, the record of autochthonous transmission of malaria in Mato Grosso included 51 (36%) out of 141 municipalities of the state in that year (IBGE, 2021). This spatial pattern changed in subsequent years, with progressive targeting of transmission in the Northwest region of the state, in particular the microregion of Aripuanã, located in the extreme northwest of Mato Grosso, bordering the states of Rondônia and Amazônia (ATANAKA-SANTOS, 2006). In 2010, 61% of the 2,365 cases of malaria recorded in Mato Grosso were transmitted in only one municipality, Colniza, belonging to the microregion. Almost half (45%) of them occurred in the district of Três Fronteiras, where a rural community of logging/sawmill workers live, and in the area of cassiterite and gold mining. The District is bordered by two Amazonian states (Rondônia and Amazônia) and is located approximately 300 km from the headquarters of the municipality of Colniza. Poor infrastructure, low-skilled human resources and scarce health service are hallmarks of this population. In 2015, 509 cases of malaria were reported in Três Fronteiras, which represented 54% of all malaria cases in Mato Grosso. Several potential factors determine and contribute to the persistence of malaria transmission in the district of Três Fronteiras. The increased exposure of the individual to the transmission, such as residing in areas close to potential breeding sites for anophelines in mining sites and in areas of dense vegetation were considered the main risk factors for the occurrence of malaria in the northwestern region of Mato Grosso (DE OLIVEIRA, 2011). The entry of people coming from non-endemic (non-immune) locations into areas of dense vegetation of the region, in order to defrorest them, explains the high transmission in this area (BRAZ, 2013). The high mobility of its population, the high vector density, the large number of breeding sites for anopheline and high involvement of people in the activities of mining and timber extraction are also relevant (BHUIYAN; ISLAM, 2022). The researchers discuss the importance of using geographic information systems as computational tools to combine environmental variables with information on malaria occurrence and the importance of spatial analysis of malaria risk stratification in specific regions, as the spread of the disease is closely related to malaria prevalence location and environment (DE OLIVEIRA, 2011; BRAZ, 2013; RAGHAVENDRA, 2022; ATANAKA, 2006; SILVA, 2019; BARBOSA, 2019). They also mention that georeferencing is one of the most relevant methods for medicine, because through it, it is possible to locate the populations at greatest risk and thus trace control measures to intervene in time. (YADAV, 2022). A study conducted in a settlement of farmers’ families in a city in the northwest of Mato Grosso showed that there is a relationship between the spatial configuration of environmental changes and the risk of falling ill due to malaria (DE OLIVEIRA, 2013). The objective of this study was to analyze the epidemiological profile of malaria in a rural community in the northwestern region of Mato Grosso, emphasizing its spatial pattern of occurrence. Methodology Study area The study was conducted in the district of Três Fronteiras (DTF), ciy of Colniza, northwestern region of Mato Grosso, located on the border with the state of Rondônia and Amazônia, 1,530 km distant from the capital city of Cuiabá (Figure 1). The health service in the FTD is scarce, having only a health clinic that performs exams of malaria and basic nursing care. The community of the FTD has no basic sanitation, electricity, access to mobile phones or landlines. In the rainy period, there is limited access to the DTF, due to the precarious state of the roads between the district and neighboring cities. Its main economic activities are cassiterite mining, gold prospecting and the timber exploitation (COLNIZA, 2014). The estimated population of DTF is 2000 people. However, there is an intense migratory flow between people of the three bordering states, due to their economic activities. During certain period of the year, many workers live in the DTF, usually during the non-rainy months. During the rainy period, they move to one of the larger cities in the region (Machadinho-RO). For the analysis of the geographical distribution of malaria cases, the area of the DTF was divided into three strata: Mining Company (Cassiterite/Gold mining), Logging/Sawmills and Village. The Mining Company stratum contain the mining locations São Francisco, Fazenda Comil and Igarapé Grande Artisanal Mining. The Logging/Sawmills concentrates loggers, sawmills and rolling mills. Village comprises the Village of Três Fronteiras, in addition to the households located on Rodovia do Estanho , from BR 174 through Lagoa das Conchas and Vila T (Figure 1). Type of study: Descriptive study of the ecological type, comprising information on the prevalence of infection by plasmodium and the use and occupation of the land by the population from DTF in July 2011. The prevalence of infection was obtained from a hemoscopic investigation of all (100%) inhabitants of DTF, which provided records of sociodemographic, clinical and exposure characteristics. Data collection and treatment Epidemiological data After consent of voluntary participation, the notification form of the official system of epidemiological surveillance of malaria was fulfilled, and an interview was performed to obtain demographic, socioeconomic and exposure data for each participant. Furthermore, the infection by Plasmodium was researched in each individual residing in the household by blood collection from the digital pulp for manufacture of thick blood smear for examination by optical microscopy. The thick drop microscopic slides were stained and examined by Microscopists from DTF and forwarded for review at the Central Laboratory of the Health State Department of Mato Grosso. Individuals with a positive result in the first microscopic examination received treatment as recommended by the Ministry of Health, within a maximum of 24 hours after blood collection. The sum of the individuals participating in the hemoscopic investigation was used for the calculation of the prevalence of infection by plasmodium in each locality of the DTF. The Epidata software 3.1 was used for the construction of the data bank and exploratory data analysis. Information on spatial distribution of malária cases For collection of the geographic coordinates of the households where each individual was residing at the time of the study, a geographic positioning equipment Garmim etrex 10 - Garmim was used. The geographic coordinates obtained were later associated with the questionnaires of epidemiological data and recorded into the database. For the construction of a georeferenced database, the ArcGIS 10.1 software was used (ESRI, California, USA). The points of each household were superimposed on a map of use and occupation of land, elaborated based on visual classification (DE OLIVEIRA et al 2013) of a TM-Landsat 5 multispectral image in 2011, obtained in the catalog of images of the Instituto Nacional de Pesquisas Espaciais (National Institute of Space Researches). Information on the use and occupation of the soil obtained according to De Oliveira et al., 2011 and in accordance with multispectral image displayed: dense arboreal vegetation, predominance of forest formations without indication of anthropic interference (deforestation); deforested area, in case of predominance of open areas for villages, pastureland, mining and/or prospecting; undergrowth vegetation and sparse trees, predominance of natural vegetation in regeneration phase and presence of isolated trees. This stratification did not allow determining the extensions for each type of use and occupation in the area of the DTF. Subsequently, a map of the distribution of malaria cases by each locality was built, incorporating information on the use and occupation of the soil. Using the TerraView freeware, version 3.14, available on the website www.dpi.inpe.br/terraview, the kernel map was built, to check the density of cases and their location. It required using the spatial interpolation method, which allows estimating the density of the event under study, in this case, the prevalent cases of infection by plasmodium. For the identification of areas with greater intensity of prevalence, the maps were constructed with a grid of 385 columns on the events and quartic function algorithm with adaptive radius (CÂMARA et al, 2004). The degree of smoothing was controlled with the adoption of the bandwidth of 30 meters. This width intended to detect a specific pattern of distribution of cases, once the radius of influence (bandwidth), which defines the neighborhood of interpolated point, if too small, can generate a very discontinuous surface and, if tool arge, the surface can be very smooth, preventing an adequate result analysis. Six individuals had to be excluded from the study, whose geographical coordinate of their homes was not collected. Ethical considerations The Research Ethics Committee of the University Hospital Júlio Muller - Federal University of Mato Grosso, approved this study under protocol no. 158.109. Results Of the 621 individuals residing in the DTF who participated in the hemoscopic investigation, 434 (69.9%) were men, aged between 20 and 59 years (70.2%) and with low level of schooling, that is, with only basic education (63.6%) or without any degree of instruction (19.2 %). Of the total number of respondents, 68 (11%) were infected with plasmodium: 39 (57.4%) by P. vivax , 27 (39.7%) by P. falciparum and two (2.9%) by mixed infection. Among those infected, 49 (72.1%) were men and 19 (27.9%), women, with 76.5% aged between 20 and 59 years and educational profile similar to that of the general population. Some type of clinical manifestation was reported by 39 (57.4%) infected individuals, while the remaining 29 (42.6%) were asymptomatic at the time of interview (Table 1). The Mining Company had the highest prevalence of infection (17.5%), followed by Timber/Sawmill area (11.7%). The overall prevalence of infection in the DTF was 11.0% (Table 2). Table 1 – Characteristics of the individuals infected by plasmodium, identified in the hemoscopic investigation performed in the population from the District of Três Fronteiras, Colniza, MT, 2011, according top lace of residence. Variable Place of residence Total Village Mining Company Timber/Sawmills n % n % n % n % Gender Male 7 58.3 33 78.6 9 64.3 49 72.1 Female 5 41.7 9 21.4 5 35.7 19 27.9 Age group 1 - 9 2 16.7 2 4.8 2 14.3 6 8.8 10 - 14 1 8.3 - - 3 21.4 4 5.9 15 - 19 1 8.3 3 7.1 - - 4 5.9 20 - 39 7 58.3 22 52.4 8 57.1 37 54.4 40 - 59 - - 14 33.3 1 7.1 15 22.1 > 60 1 8.3 1 2.4 - - 2 2.9 Education None 2 16.7 7 16.7 4 28.6 13 19.1 Elementary school 9 75.0 28 66.7 7 50.0 44 64.7 High school 1 8.3 6 14.3 3 21.4 10 14.7 College - - 1 2.4 - - 1 1.5 Exam result P. falciparum 3 25.0 21 50.0 3 21.4 27 39.7 P. vivax 9 75.0 19 45.2 11 78.6 39 57.4 Mixed infection - - 2 4.8 - - 2 2.9 Symptoms Yes 6 50.0 23 54.8 10 71.4 39 57.4 No 6 50.0 19 45.2 4 28.6 29 42.6 The overlapping analysis of infected individuals on a map of occupation and use of the land showed that the transmission occurs as the extension of the DTF, with greater frequency in open areas, close to the mining company/artisanal mining, followed by the existing timber/sawmills. The total DTF area is 55,014.85 hectares, and 72,565.64 hectares of dense arboreal vegetation (75.8%), 7,611.70 hectares of deforested area (10.5%) and 9,939.09 of undergrowth vegetation and sparse trees (13.7%). In addition to observing a greater concentration (85.3%) of infected individuals in deforested areas and in areas with sparse and undergrowth vegetation, deforested areas contributed most (69.1%) with the prevalence of infection in the DTF (Figure 2). Consistently, the hot areas of the kernel map, that is, with a greater frequency of infection by plasmodium, were also identified in the localities of gold mining, in which deforested areas and undergrowth vegetation and spares trees (Figure 3). Infected and asymptomatic individuals at the time of the survey were more frequent (45.2%) in the mining and prospecting area, where, in turn, deforested areas with undergrowth vegetation and sparse trees and dense arboreal vegetation concentrate (Figure 4). Discussion Among the Plasmodium species (P. vivax, P. falciparum , P. Ovale , and P. Malarie ), in this study, there was a higher frequency of infection by P. vivax and in males. In recent years, P . vivax infection has become predominant in the Amazon region, where only 16.3% of infections are caused by P. falciparum (SOUSA, 2020; RODRIGUES, 2020; SILVINA, 2019). Thus, while this shift in prevalence has contributed to an overall reduction in the number of malaria infections (MAKANJUOLA, 2020), there is still a high prevalence in rural areas due to geographical factors and lack of resources and infrastructure (DA COSTA, 2022). Based on the data from the hemoscopic survey held in July 2011 in the DTF, the prevalence of infection by plasmodium was 11%, which characterizes the region as mesoendemic for malaria. The epidemiological assessment of non-perennial transmission areas is the determination of the prevalence of parasitemia by plasmodium in the population, determined through hemoscopic surveys, and which also classifies the regions as hypoendemic, mesoendemic, hyperendemic and holoendemic if the proportion of infected individuals are >0-10%, 11-50%, 51-75% and >75%, respectively. Thus, a prevalence of 24.2% of malaria was observed in the population, which determined the area as mesoendemic. Therefore, it is necessary to measure the level of endemicity in regular periods in order to evaluate the effectiveness of control activities. Individuals who reported having some type of symptom at the collection concentrated in the mining and logging areas. In these areas, there were also individuals who did not show any clinical manifestation. Even without evidence that active search for malaria elimination is effective, research indicates that investigations may be more effective as an intervention strategy because they can identify asymptomatic individuals, thus reducing transmission (DA COSTA, 2022; MENDES, 2020). In this sense, further studies should be conducted to clarify the doubts regarding individuals with asymptomatic malaria. Prevalence in the study area occurred more frequently in cassiterite and gold mining locations, which could possibly be related to work activities, since individuals work in endemic areas and do not use preventive measures, thus favoring the transmission of the disease. With respect to the type of use and occupation of the soil, the study area presents the occurrence of malaria cases in regions of deforested areas and/or areas with undergrowth vegetation and sparse trees, since the deforestation for timber extraction and other activities contribute to the occurrence of disease transmission (WYREPKOWSKI, 2021). Corroborating the research, there are studies showing that deforestation, mining areas and also forest remnants, contribute to the occurrence of malaria and the areas with greater wood extraction showed a low incidence of the disease (CHAVES, 2018). In this scenario, in which the anthropic process is evident, the high environmental modification contributes to the occurrence of cases as presented in this research, which showed that the highest incidence of malaria occurred in mining regions. Other research conducted in areas with similar characteristics, corroborate the results observed in this study, whose authors found that the prevalence of malaria appeared with the creation of mining camps and more frequently in houses near the prospecting zone (LOPES et al, 2019). The distance of these areas from major health centres may be one of the factors contributing to the concentration of cases, since the delay in seeking care and obtaining the diagnosis to start treatment determines an increase in the transmission period, thus generating a high number of new cases (SILVA et al, 2021). Research carried out in Mato Grosso found evidence between the occurrence of cases of malaria and prospecting activities, reinforcing the analyses made in this state by other authors (SILVA et al, 2021; LIMA et al, 2022). The proportion of miners with undiagnosed malaria contributes to the collective transmission of the disease, causing a concentration of cases that can evolve into outbreaks of this pathology (LIMA et al, 2022). Hemoscopic investigations are still a great challenge, as it is necessary to have an effective strategy to prevent and control plasmodium infection, requiring trained individuals to identify the parasite and correctly dispense drugs when diagnosing infected individuals. (EBHUOMA, 2016). Conclusion This study allowed concluding that the transmission of malaria in the District of Três Fronteiras has a heterogeneous profile along its length, and that the individuals residing in mining, prospecting and timber extraction areas have a higher frequency of infection by plasmodium and that its spatial pattern also has different intensity of distribution of the disease. Declarations Ethics approval and consent to participate The Research Ethics Committee of the University Hospital Júlio Muller - Federal University of Mato Grosso, approved this study under protocol no. 158.109 of 29 November 2012; CAAE: 08500612.3.0000.5541 Availability of data and materials All data generated or analysed during this study are included in this published article [and its supplementary information files]. Competing interests The authors declare that there are no conflicts of interests. Funding Conselho Nacional de Pesquisa – CNPq (National Research Council) (Process 555652/2009-2) and the Fundação de Amparo à Pesquisa do Estado de Mato Grosso (FAPEMAT) (Research Support State Foundation of Mato Grosso), PRONEX-Network Malaria, Mato Grosso. Authors' contributions CJFF ensured the financing of fieldwork, with resources from PRONEX/ Rede Malária (Malaria Network)/CNPq/FAPEMAT. ECO, ESS and PAFJ contributed to the study design, acquisition and interpretation of data, statistical analysis, and writing of the manuscript. ESS, MAS and CJFF participated in the study concept, coordination and critical review of the manuscript. ACPT, MCPL and ERFL participated in the writing and critical review of the manuscript. All authors have read and approved the final manuscript. Acknowledgements We would like to thank the direct and indirect collaborators of this study, in particular to the technicians of the laboratory for malaria diagnosis in the District of Três Fronteiras: Ana Cléa, Clarice and Romário Gurgel. We would also like to thank the team of the Master's Degree in Nursing of the UFMT for contributing in field activities, and the Coordination of Epidemiological Surveillance and the technicians at LACEN-MT and Malaria Laboratory of the University Hospital Júlio Muller, for their support in the review of the microscopic diagnosis of malaria. 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"Surto de malária em área de mineração situada no Vale do Rio Jequitinhonha, Estado de Minas Gerais: Malaria outbreak in a mining area located in the Jequitinhonha River Valley, State of Minas Gerais." Health and Biosciences 2.2 (2021): 29-37. https://scholar.archive.org/work/ql5xtrrwindyvidsljmcupzl2y/access/wayback/https://periodicos.ufes.br/healthandbiosciences/article/download/35132/23853 Lima, Ana Elisa Oliveira, Assis do Carmo Pereira Júnior, and Rosana Passos Cambraia. "Caracterização epidemiológica do surto de malária na região do garimpo Areinha, Alto Vale do Jequitinhonha, Minas Gerais, Brasil." Research, Society and Development 11.12 (2022): e119111234236-e119111234236. https://rsdjournal.org/index.php/rsd/article/view/34236 Ebhuoma, Osadolor e Michael Gebreslasie. "Variáveis climáticas/ambientais baseadas em sensoriamento remoto para modelar a transmissão da malária na África Subsaariana." Jornal internacional de pesquisa ambiental e saúde pública 13.6 (2016): 584. https://www.mdpi.com/143898 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 05 Aug, 2024 Read the published version in Malaria Journal → Version 1 posted Editorial decision: Major revision 05 Jun, 2023 Reviews received at journal 21 Apr, 2023 Reviewers agreed at journal 31 Mar, 2023 Reviewers invited by journal 31 Mar, 2023 Submission checks completed at journal 29 Mar, 2023 Editor assigned by journal 29 Mar, 2023 First submitted to journal 28 Mar, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2749203","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":187442129,"identity":"bc8666fd-18f7-4488-9001-95c69d390a72","order_by":0,"name":"Elaine Cristina De Oliveira","email":"","orcid":"","institution":"Medicine College, University Hospital Júlio Müller. Federal University of Mato Grosso","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Elaine","middleName":"Cristina","lastName":"De Oliveira","suffix":""},{"id":187442130,"identity":"941a9775-9e8e-46d2-afc2-2ec4273fef8f","order_by":1,"name":"Emerson Soares dos Santos","email":"","orcid":"","institution":"Federal University of Mato Grosso","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Emerson","middleName":"Soares dos","lastName":"Santos","suffix":""},{"id":187442132,"identity":"0d921196-11e7-40b2-a838-8efa770735eb","order_by":2,"name":"Paulo Antonio Ferreira Junior","email":"","orcid":"","institution":"Medicine College, University Hospital Júlio Müller. Federal University of Mato Grosso","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Paulo","middleName":"Antonio Ferreira","lastName":"Junior","suffix":""},{"id":187442134,"identity":"af585f38-4a97-47d2-a080-6fea3f39bd9d","order_by":3,"name":"Marina Atanaka-Santos","email":"","orcid":"","institution":"Federal University of Mato Grosso","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Marina","middleName":"","lastName":"Atanaka-Santos","suffix":""},{"id":187442136,"identity":"46efb759-efab-40b4-a40a-41703f3b13d2","order_by":4,"name":"Maria Clara Pereira Leite","email":"","orcid":"","institution":"State University of Mato Grosso","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Maria","middleName":"Clara Pereira","lastName":"Leite","suffix":""},{"id":187442138,"identity":"8304720d-8c76-47a8-8e14-5e24ea376a1d","order_by":5,"name":"Ana Cláudia Pereira Terças Trettel","email":"","orcid":"","institution":"State University of Mato Grosso, Tangará da Serra (MT)","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ana","middleName":"Cláudia Pereira Terças","lastName":"Trettel","suffix":""},{"id":187442139,"identity":"a4ef29c5-949a-4702-a4c8-9726d47d963a","order_by":6,"name":"Elba Regina Sampaio Lemos","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0ElEQVRIiWNgGAWjYHACxgMgkh9EJBQQqQesRbIBpMWAFC0GEJII5fzSxx8c+JhjY298fnXihwcGDPL8Ygfwa5HsyzE4OHNbWuK2G283SwAdZjhzdgJ+LQZneBgO8247nGB24+wGkJYEg9sEtNifYX9w+O+2w/bGM85u/kGUFgMeBoPDjNsOM27g791GnC0SZ3gMDvYC/TLjBu82iwQDCcJ+4e9hf/jg5zYbe/7+s5tv/qiwkeeXJqAFyT6wSglilYPtO0CK6lEwCkbBKBhJAAB+Okdry5ymvgAAAABJRU5ErkJggg==","orcid":"","institution":"Oswaldo Cruz Foundation","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Elba","middleName":"Regina Sampaio","lastName":"Lemos","suffix":""},{"id":187442141,"identity":"1042f83c-7eb3-4bff-aaeb-e067f4a34690","order_by":7,"name":"Cor Jesus Fernandes Fontes","email":"","orcid":"","institution":"Medicine College, University Hospital Júlio Müller. Federal University of Mato Grosso","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Cor","middleName":"Jesus Fernandes","lastName":"Fontes","suffix":""}],"badges":[],"createdAt":"2023-03-29 00:59:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2749203/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2749203/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12936-024-05033-7","type":"published","date":"2024-08-05T15:57:48+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":35057545,"identity":"73327000-c429-4886-b775-663f77192371","added_by":"auto","created_at":"2023-03-30 18:19:42","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":293219,"visible":true,"origin":"","legend":"\u003cp\u003eLocation map of the District of Três Fronteiras, city of Colniza – MT, Brazil.\u003c/p\u003e","description":"","filename":"Figure1LocationmapoftheDistrictofTrsFronteirascityofColnizaMTBrazil..png","url":"https://assets-eu.researchsquare.com/files/rs-2749203/v1/7a6152ad2fb2edb55b933d4c.png"},{"id":35057546,"identity":"7e291512-bf10-43f4-8b81-2aa15d318b0f","added_by":"auto","created_at":"2023-03-30 18:19:42","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":172964,"visible":true,"origin":"","legend":"\u003cp\u003eMap of distribution of malaria cases according to type of use and occupation of soil in the District of Distrito Três Fronteiras, city of Colniza – MT, 2011.\u003c/p\u003e\n\u003cp\u003eObs: The circles in the map represent the number of cases of infection by \u003cem\u003ePlasmodium, \u003c/em\u003eits size and amount of cases in certain point.\u003c/p\u003e","description":"","filename":"Figure2MapofdistributionofmalariacasesaccordingtotypeofuseandoccupationofsoilintheDistrictofDistritoTrsFronteirascityofColnizaMT2011..png","url":"https://assets-eu.researchsquare.com/files/rs-2749203/v1/baafaf6568f1f60cf39c914c.png"},{"id":35057547,"identity":"43412360-9e00-4b60-8cbd-b4beb9a33fd4","added_by":"auto","created_at":"2023-03-30 18:19:42","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":395118,"visible":true,"origin":"","legend":"\u003cp\u003eKernel map of malaria cases in the District of Três Fronteiras, city of Colniza – MT, 2011.\u003c/p\u003e","description":"","filename":"Figure3KernelmapofmalariacasesintheDistrictofTrsFronteirascityofColnizaMT2011..png","url":"https://assets-eu.researchsquare.com/files/rs-2749203/v1/7aaf116c13e97fc7d39ff67c.png"},{"id":35057548,"identity":"04757e9d-7b45-4020-86e2-8ad8da2d3c92","added_by":"auto","created_at":"2023-03-30 18:19:42","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":161603,"visible":true,"origin":"","legend":"\u003cp\u003eMap of distribution of asymptomatic and symptomatic individuals infected by plasmodium at the hemoscopic investigation, according to the type of use and occupation of soil in the District of Três Fronteiras, Colniza – MT, 2011.\u003c/p\u003e","description":"","filename":"Figure4MapofdistributionofasymptomaticandsymptomaticindividualsinfectedbyplasmodiumatthehemoscopicinvestigationaccordingtothetypeofuseandoccupationofsoilintheDistrictofTrsFronteirasColniz.png","url":"https://assets-eu.researchsquare.com/files/rs-2749203/v1/68803cdeb0cf5452ec7d453a.png"},{"id":62298490,"identity":"9b946579-f629-46a2-82fb-31fe448cf46d","added_by":"auto","created_at":"2024-08-12 16:13:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1709080,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2749203/v1/21fb9ae3-5238-43dc-9ddf-b2a189095179.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eEpidemiological Profile of Malaria in a Rural Community From the Amazon of Mato Grosso\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMalaria is considered a serious public health problem worldwide, being responsible for the greatest increase in morbidity and mortality in countries with tropical and subtropical climates. Caused by protozoa of the \u003cem\u003ePlasmodium genus\u003c/em\u003e, the female \u003cem\u003eAnopheles\u0026nbsp;\u003c/em\u003eis responsible for transmitting the disease (WHO, 2018).\u003c/p\u003e\n\u003cp\u003eAccording to the World Health Organization, around 241 million cases of malaria were reported in 2020 in 85 endemic countries, 6.2% higher than the 2019 data (227 million). Estimates show that 3.4 billion people are at risk of malaria worldwide\u0026nbsp;(WHO, 2022).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; It accounts for 99% of the cases of this infection of autochthonous origin in the regions known as Amaz\u0026ocirc;nia Legal, which includes the states of Acre, Amap\u0026aacute;, Amazonas, Maranh\u0026atilde;o, Mato Grosso, Rond\u0026ocirc;nia, Roraima and Tocantins, comprising 807 municipalities of different territorial extensions and population sizes. (FIOCRUZ, 2019).\u003c/p\u003e\n\u003cp\u003eAlthough its incidence is decreasing with about 8% (18.5 million) in 2000, to 2% (4.5 million) in 2020, the number of deaths from malaria in a period from 2000 (896,000) to 2019 (558,000) there was a reduction of about 60.6% however when comparing the year 2019 with 2020, there is an increase of 12% (627. 000) in the number of deaths, this is due to the fact that in this period occurred the emergence of the pandemic of COVID-19 and consequently with the social isolation and the interruptions of various health services, favored for this growth\u0026nbsp;(WHO, 2021).\u003c/p\u003e\n\u003cp\u003eThe state of Mato Grosso, although hyperendemic for malaria in the 1980\u0026rsquo;s and the beginning of the 1990\u0026rsquo;s, has been presenting significant reduction of transmission in recent years. The comparison between the numbers recorded in 2011 and 2000 shows a reduction of 86.1% in the number of cases of the disease. This proportional reduction ranked Mato Grosso as the state of Legal Amazon that contributed the most for the control of malaria in Brazil, in this new millennium (BRAZIL, 2013).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDespite its heterogeneous geographical distribution until 2003, the record of autochthonous transmission of malaria in Mato Grosso included 51 (36%) out of 141 municipalities of the state in that year (IBGE, 2021). This spatial pattern changed in subsequent years, with progressive targeting of transmission in the Northwest region of the state, in particular the microregion of Aripuan\u0026atilde;, located in the extreme northwest of Mato Grosso, bordering the states of Rond\u0026ocirc;nia and Amaz\u0026ocirc;nia (ATANAKA-SANTOS, 2006).\u003c/p\u003e\n\u003cp\u003eIn 2010, 61% of the 2,365 cases of malaria recorded in Mato Grosso were transmitted in only one municipality, Colniza, belonging to the microregion. Almost half (45%) of them occurred in the district of Tr\u0026ecirc;s Fronteiras, where a rural community of logging/sawmill workers live, and in the area of cassiterite and gold mining. The District is bordered by two Amazonian states (Rond\u0026ocirc;nia and Amaz\u0026ocirc;nia) and is located approximately 300 km from the headquarters of the municipality of Colniza. Poor infrastructure, low-skilled human resources and scarce health service are hallmarks of this population. In 2015, 509 cases of malaria were reported in Tr\u0026ecirc;s Fronteiras, which represented 54% of all malaria cases in Mato Grosso.\u003c/p\u003e\n\u003cp\u003eSeveral potential factors determine and contribute to the persistence of malaria transmission in the district of Tr\u0026ecirc;s Fronteiras. The increased exposure of the individual to the transmission, such as residing in areas close to potential breeding sites for anophelines in mining sites and in areas of dense vegetation were considered the main risk factors for the occurrence of malaria in the northwestern region of Mato Grosso (DE OLIVEIRA, 2011).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe entry of people coming from non-endemic (non-immune) locations into areas of dense vegetation of the region, in order to defrorest them, explains the high transmission in this area (BRAZ, 2013). The high mobility of its population, the high vector density, the large number of breeding sites for anopheline and high involvement of people in the activities of mining and timber extraction are also relevant (BHUIYAN; ISLAM, 2022).\u003c/p\u003e\n\u003cp\u003eThe researchers discuss the importance of using geographic information systems as computational tools to combine environmental variables with information on malaria occurrence and the importance of spatial analysis of malaria risk stratification in specific regions, as the spread of the disease is closely related to malaria prevalence location and environment (DE OLIVEIRA, 2011; BRAZ, 2013;\u0026nbsp;RAGHAVENDRA, 2022; ATANAKA, 2006; SILVA, 2019; BARBOSA, 2019).\u0026nbsp;They also mention that georeferencing is one of the most relevant methods for medicine, because through it, it is possible to locate the populations at greatest risk and thus trace control measures to intervene in time. (YADAV, 2022). A study conducted in a settlement of farmers\u0026rsquo; families in a city in the northwest of Mato Grosso showed that there is a relationship between the spatial configuration of environmental changes and the risk of falling ill due to malaria (DE OLIVEIRA, 2013).\u003c/p\u003e\n\u003cp\u003eThe objective of this study was to analyze the epidemiological profile of malaria in a rural community in the northwestern region of Mato Grosso, emphasizing its spatial pattern of occurrence.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003e\u003cstrong\u003eStudy area\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in the district of Tr\u0026ecirc;s Fronteiras (DTF), ciy of Colniza, northwestern region of Mato Grosso, located on the border with the state of Rond\u0026ocirc;nia and Amaz\u0026ocirc;nia, 1,530 km distant from the capital city of Cuiab\u0026aacute; (Figure 1). The health service in the FTD is scarce, having only a health clinic that performs exams of malaria and basic nursing care. The community of the FTD has no basic sanitation, electricity, access to mobile phones or landlines. In the rainy period, there is limited access to the DTF, due to the precarious state of the roads between the district and neighboring cities. Its main economic activities are cassiterite mining, gold prospecting and the timber exploitation (COLNIZA, 2014).\u003c/p\u003e\n\u003cp\u003eThe estimated population of DTF is 2000 people. However, there is an intense migratory flow between people of the three bordering states, due to their economic activities. During certain period of the year, many workers live in the DTF, usually during the non-rainy months. During the rainy period, they move to one of the larger cities in the region (Machadinho-RO).\u003c/p\u003e\n\u003cp\u003eFor the analysis of the geographical distribution of malaria cases, the area of the DTF was divided into three strata: Mining Company (Cassiterite/Gold mining), Logging/Sawmills and Village. The Mining Company stratum contain the mining locations S\u0026atilde;o Francisco, Fazenda Comil and Igarap\u0026eacute; Grande Artisanal Mining. The Logging/Sawmills concentrates loggers, sawmills and rolling mills. Village comprises the Village of Tr\u0026ecirc;s Fronteiras, in addition to the households located on \u003cem\u003eRodovia do Estanho\u003c/em\u003e, from BR 174 through Lagoa das Conchas and Vila T (Figure 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eType of study:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDescriptive study of the ecological type, comprising information on the prevalence of infection by plasmodium and the use and occupation of the land by the population from DTF in July 2011. The prevalence of infection was obtained from a hemoscopic investigation of all (100%) inhabitants of DTF, which provided records of sociodemographic, clinical and exposure characteristics.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eData collection and treatment\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEpidemiological data\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter consent of voluntary participation, the notification form of the official system of epidemiological surveillance of malaria was fulfilled, and an interview was performed to obtain demographic, socioeconomic and exposure data for each participant. Furthermore, the infection by Plasmodium was researched in each individual residing in the household by blood collection from the digital pulp for manufacture of thick blood smear for examination by optical microscopy. The thick drop microscopic slides were stained and examined by Microscopists from DTF and forwarded for review at the Central Laboratory of the Health State Department of Mato Grosso. Individuals with a positive result in the first microscopic examination received treatment as recommended by the Ministry of Health, within a maximum of 24 hours after blood collection.\u003c/p\u003e\n\u003cp\u003eThe sum of the individuals participating in the hemoscopic investigation was used for the calculation of the prevalence of infection by plasmodium in each locality of the DTF. The Epidata software 3.1 was used for the construction of the data bank and exploratory data analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eInformation on spatial distribution of mal\u0026aacute;ria cases\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFor collection of the geographic coordinates of the households where each individual was residing at the time of the study, a geographic positioning equipment Garmim etrex 10 - Garmim was used. The geographic coordinates obtained were later associated with the questionnaires of epidemiological data and recorded into the database. For the construction of a georeferenced database, the ArcGIS 10.1 software was used (ESRI, California, USA). The points of each household were superimposed on a map of use and occupation of land, elaborated based on visual classification (DE OLIVEIRA et al 2013) of a TM-Landsat 5 multispectral image in 2011, obtained in the catalog of images of the \u003cem\u003eInstituto Nacional de Pesquisas Espaciais\u003c/em\u003e (National Institute of Space Researches).\u003c/p\u003e\n\u003cp\u003eInformation on the use and occupation of the soil obtained according to De Oliveira et al., 2011 and in accordance with multispectral image displayed: dense arboreal vegetation, predominance of forest formations without indication of anthropic interference (deforestation); deforested area, in case of predominance of open areas for villages, pastureland, mining and/or prospecting; undergrowth vegetation and sparse trees, predominance of natural vegetation in regeneration phase and presence of isolated trees. This stratification did not allow determining the extensions for each type of use and occupation in the area of the DTF. Subsequently, a map of the distribution of malaria cases by each locality was built, incorporating information on the use and occupation of the soil.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eUsing the TerraView freeware, version 3.14, available on the website www.dpi.inpe.br/terraview, the kernel map was built, to check the density of cases and their location. It required using the spatial interpolation method, which allows estimating the density of the event under study, in this case, the prevalent cases of infection by plasmodium. For the identification of areas with greater intensity of prevalence, the maps were constructed with a grid of 385 columns on the events and quartic function algorithm with adaptive radius (C\u0026Acirc;MARA et al, 2004).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe degree of smoothing was controlled with the adoption of the bandwidth of 30 meters. This width intended to detect a specific pattern of distribution of cases, once the radius of influence (bandwidth), which defines the neighborhood of interpolated point, if too small, can generate a very discontinuous surface and, if tool arge, the surface can be very smooth, preventing an adequate result analysis. Six individuals had to be excluded from the study, whose geographical coordinate of their homes was not collected.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eEthical considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Research Ethics Committee of the University Hospital J\u0026uacute;lio Muller - Federal University of Mato Grosso, approved this study under protocol no. 158.109.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eOf the 621 individuals residing in the DTF who participated in the hemoscopic investigation, 434 (69.9%) were men, aged between 20 and 59 years (70.2%) and with low level of schooling, that is, with only basic education (63.6%) or without any degree of instruction (19.2 %).\u003c/p\u003e\n\u003cp\u003eOf the total number of respondents, 68 (11%) were infected with plasmodium: 39 (57.4%) by \u003cem\u003eP. vivax\u003c/em\u003e, 27 (39.7%) by \u003cem\u003eP. falciparum\u003c/em\u003e and two (2.9%) by mixed infection. Among those infected, 49 (72.1%) were men and 19 (27.9%), women, with 76.5% aged between 20 and 59 years and educational profile similar to that of the general population. Some type of clinical manifestation was reported by 39 (57.4%) infected individuals, while the remaining 29 (42.6%) were asymptomatic at the time of interview (Table 1). The Mining Company had the highest prevalence of infection (17.5%), followed by Timber/Sawmill area (11.7%). The overall prevalence of infection in the DTF was 11.0% (Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e \u0026ndash; Characteristics of the individuals infected by plasmodium, identified in the hemoscopic investigation performed in the population from the District of Tr\u0026ecirc;s Fronteiras, Colniza, MT, 2011, according top lace of residence.\u003c/p\u003e\n\u003ctable border=\"0\" cellpadding=\"0\" cellspacing=\"0\" width=\"562\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" width=\"24.02135231316726%\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" valign=\"bottom\" width=\"58.54092526690391%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePlace of residence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" width=\"17.437722419928825%\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" width=\"34.04255319148936%\"\u003e\n \u003cp\u003e\u003cstrong\u003eVillage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"28.571428571428573%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMining Company\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"37.38601823708207%\"\u003e\n \u003cp\u003e\u003cstrong\u003eTimber/Sawmills\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.97868561278863%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.170515097690942%\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"11.72291296625222%\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"6.74955595026643%\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"10.124333925399645%\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.348134991119005%\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"13.49911190053286%\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.170515097690942%\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"9.236234458259325%\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" width=\"23.97868561278863%\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.170515097690942%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"11.72291296625222%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"6.74955595026643%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"10.124333925399645%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.348134991119005%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"13.49911190053286%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.170515097690942%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"9.236234458259325%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" width=\"23.97868561278863%\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.170515097690942%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"11.72291296625222%\"\u003e\n \u003cp\u003e58.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"6.74955595026643%\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"10.124333925399645%\"\u003e\n \u003cp\u003e78.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.348134991119005%\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"13.49911190053286%\"\u003e\n \u003cp\u003e64.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.170515097690942%\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"9.236234458259325%\"\u003e\n \u003cp\u003e72.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" width=\"23.97868561278863%\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.170515097690942%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"11.72291296625222%\"\u003e\n \u003cp\u003e41.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"6.74955595026643%\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"10.124333925399645%\"\u003e\n \u003cp\u003e21.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.348134991119005%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"13.49911190053286%\"\u003e\n \u003cp\u003e35.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.170515097690942%\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"9.236234458259325%\"\u003e\n \u003cp\u003e27.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" width=\"23.97868561278863%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.170515097690942%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"11.72291296625222%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"6.74955595026643%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"10.124333925399645%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.348134991119005%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"13.49911190053286%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.170515097690942%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"9.236234458259325%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" width=\"23.97868561278863%\"\u003e\n \u003cp\u003e1 - 9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.170515097690942%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"11.72291296625222%\"\u003e\n \u003cp\u003e16.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"6.74955595026643%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"10.124333925399645%\"\u003e\n \u003cp\u003e4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.348134991119005%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"13.49911190053286%\"\u003e\n \u003cp\u003e14.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.170515097690942%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"9.236234458259325%\"\u003e\n \u003cp\u003e8.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" width=\"23.97868561278863%\"\u003e\n \u003cp\u003e10 - 14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.170515097690942%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"11.72291296625222%\"\u003e\n \u003cp\u003e8.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"6.74955595026643%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"10.124333925399645%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.348134991119005%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"13.49911190053286%\"\u003e\n \u003cp\u003e21.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.170515097690942%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"9.236234458259325%\"\u003e\n \u003cp\u003e5.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" width=\"23.97868561278863%\"\u003e\n \u003cp\u003e15 - 19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.170515097690942%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"11.72291296625222%\"\u003e\n \u003cp\u003e8.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"6.74955595026643%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"10.124333925399645%\"\u003e\n \u003cp\u003e7.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.348134991119005%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"13.49911190053286%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.170515097690942%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"9.236234458259325%\"\u003e\n \u003cp\u003e5.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" width=\"23.97868561278863%\"\u003e\n \u003cp\u003e20 - 39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.170515097690942%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"11.72291296625222%\"\u003e\n \u003cp\u003e58.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"6.74955595026643%\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"10.124333925399645%\"\u003e\n \u003cp\u003e52.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.348134991119005%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"13.49911190053286%\"\u003e\n \u003cp\u003e57.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.170515097690942%\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"9.236234458259325%\"\u003e\n \u003cp\u003e54.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" width=\"23.97868561278863%\"\u003e\n \u003cp\u003e40 - 59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.170515097690942%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"11.72291296625222%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"6.74955595026643%\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"10.124333925399645%\"\u003e\n \u003cp\u003e33.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.348134991119005%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"13.49911190053286%\"\u003e\n \u003cp\u003e7.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.170515097690942%\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"9.236234458259325%\"\u003e\n \u003cp\u003e22.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" width=\"23.97868561278863%\"\u003e\n \u003cp\u003e\u0026gt; 60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.170515097690942%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"11.72291296625222%\"\u003e\n \u003cp\u003e8.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"6.74955595026643%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"10.124333925399645%\"\u003e\n \u003cp\u003e2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.348134991119005%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"13.49911190053286%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.170515097690942%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"9.236234458259325%\"\u003e\n \u003cp\u003e2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" width=\"23.97868561278863%\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.170515097690942%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"11.72291296625222%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"6.74955595026643%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"10.124333925399645%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.348134991119005%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"13.49911190053286%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.170515097690942%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"9.236234458259325%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" width=\"23.97868561278863%\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.170515097690942%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"11.72291296625222%\"\u003e\n \u003cp\u003e16.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"6.74955595026643%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"10.124333925399645%\"\u003e\n \u003cp\u003e16.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.348134991119005%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"13.49911190053286%\"\u003e\n \u003cp\u003e28.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.170515097690942%\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"9.236234458259325%\"\u003e\n \u003cp\u003e19.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" width=\"23.97868561278863%\"\u003e\n \u003cp\u003eElementary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.170515097690942%\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"11.72291296625222%\"\u003e\n \u003cp\u003e75.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"6.74955595026643%\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"10.124333925399645%\"\u003e\n \u003cp\u003e66.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.348134991119005%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"13.49911190053286%\"\u003e\n \u003cp\u003e50.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.170515097690942%\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"9.236234458259325%\"\u003e\n \u003cp\u003e64.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" width=\"23.97868561278863%\"\u003e\n \u003cp\u003eHigh school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.170515097690942%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"11.72291296625222%\"\u003e\n \u003cp\u003e8.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"6.74955595026643%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"10.124333925399645%\"\u003e\n \u003cp\u003e14.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.348134991119005%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"13.49911190053286%\"\u003e\n \u003cp\u003e21.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.170515097690942%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"9.236234458259325%\"\u003e\n \u003cp\u003e14.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" width=\"23.97868561278863%\"\u003e\n \u003cp\u003eCollege\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.170515097690942%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"11.72291296625222%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"6.74955595026643%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"10.124333925399645%\"\u003e\n \u003cp\u003e2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.348134991119005%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"13.49911190053286%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.170515097690942%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"9.236234458259325%\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" width=\"23.97868561278863%\"\u003e\n \u003cp\u003e\u003cstrong\u003eExam result\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.170515097690942%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"11.72291296625222%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"6.74955595026643%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"10.124333925399645%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.348134991119005%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"13.49911190053286%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.170515097690942%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"9.236234458259325%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" width=\"23.97868561278863%\"\u003e\n \u003cp\u003e\u003cem\u003eP. falciparum\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.170515097690942%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"11.72291296625222%\"\u003e\n \u003cp\u003e25.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"6.74955595026643%\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"10.124333925399645%\"\u003e\n \u003cp\u003e50.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.348134991119005%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"13.49911190053286%\"\u003e\n \u003cp\u003e21.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.170515097690942%\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"9.236234458259325%\"\u003e\n \u003cp\u003e39.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" width=\"23.97868561278863%\"\u003e\n \u003cp\u003e\u003cem\u003eP. vivax\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.170515097690942%\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"11.72291296625222%\"\u003e\n \u003cp\u003e75.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"6.74955595026643%\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"10.124333925399645%\"\u003e\n \u003cp\u003e45.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.348134991119005%\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"13.49911190053286%\"\u003e\n \u003cp\u003e78.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.170515097690942%\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"9.236234458259325%\"\u003e\n \u003cp\u003e57.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" width=\"23.97868561278863%\"\u003e\n \u003cp\u003eMixed infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.170515097690942%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"11.72291296625222%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"6.74955595026643%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"10.124333925399645%\"\u003e\n \u003cp\u003e4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.348134991119005%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"13.49911190053286%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.170515097690942%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"9.236234458259325%\"\u003e\n \u003cp\u003e2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" width=\"23.97868561278863%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSymptoms\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.170515097690942%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"11.72291296625222%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"6.74955595026643%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"10.124333925399645%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.348134991119005%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"13.49911190053286%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.170515097690942%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"9.236234458259325%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" width=\"23.97868561278863%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.170515097690942%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"11.72291296625222%\"\u003e\n \u003cp\u003e50.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"6.74955595026643%\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"10.124333925399645%\"\u003e\n \u003cp\u003e54.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.348134991119005%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"13.49911190053286%\"\u003e\n \u003cp\u003e71.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.170515097690942%\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"9.236234458259325%\"\u003e\n \u003cp\u003e57.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" width=\"23.97868561278863%\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.170515097690942%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"11.72291296625222%\"\u003e\n \u003cp\u003e50.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"6.74955595026643%\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"10.124333925399645%\"\u003e\n \u003cp\u003e45.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.348134991119005%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"13.49911190053286%\"\u003e\n \u003cp\u003e28.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"8.170515097690942%\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" width=\"9.236234458259325%\"\u003e\n \u003cp\u003e42.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cimg src=\"https://myfiles.space/user_files/122228_c8a1650c59388082/122228_custom_files/img1680181526.png\"\u003e\u003c/p\u003e\n\u003cp\u003eThe overlapping analysis of infected individuals on a map of occupation and use of the land showed that the transmission occurs as the extension of the DTF, with greater frequency in open areas, close to the mining company/artisanal mining, followed by the existing timber/sawmills.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe total DTF area is 55,014.85 hectares, and 72,565.64 hectares of dense arboreal vegetation (75.8%), 7,611.70 hectares of deforested area (10.5%) and 9,939.09 of undergrowth vegetation and sparse trees (13.7%). In addition to observing a greater concentration (85.3%) of infected individuals in deforested areas and in areas with sparse and undergrowth vegetation, deforested areas contributed most (69.1%) with the prevalence of infection in the DTF (Figure 2). Consistently, the hot areas of the kernel map, that is, with a greater frequency of infection by plasmodium, were also identified in the localities of gold mining, in which deforested areas and undergrowth vegetation and spares trees (Figure 3).\u003c/p\u003e\n\u003cp\u003eInfected and asymptomatic individuals at the time of the survey were more frequent (45.2%) in the mining and prospecting area, where, in turn, deforested areas with undergrowth vegetation and sparse trees and dense arboreal vegetation concentrate (Figure 4).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAmong the \u003cem\u003ePlasmodium\u003c/em\u003e species (P. \u003cem\u003evivax,\u003c/em\u003e P. \u003cem\u003efalciparum\u003c/em\u003e, P. \u003cem\u003eOvale\u003c/em\u003e, and P. \u003cem\u003eMalarie\u003c/em\u003e), in this study, there was a higher frequency of infection by P. \u003cem\u003evivax\u003c/em\u003e and in males. In recent years, P\u003cem\u003e. vivax\u003c/em\u003e infection has become predominant in the Amazon region, where only 16.3% of infections are caused by P. \u003cem\u003efalciparum\u003c/em\u003e (SOUSA, 2020; RODRIGUES, 2020; SILVINA, 2019). Thus, while this shift in prevalence has contributed to an overall reduction in the number of malaria infections (MAKANJUOLA, 2020), there is still a high prevalence in rural areas due to geographical factors and lack of resources and infrastructure (DA COSTA, 2022).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBased on the data from the hemoscopic survey held in July 2011 in the DTF, the prevalence of infection by plasmodium was 11%, which characterizes the region as mesoendemic for malaria. The epidemiological assessment of non-perennial transmission areas is the determination of the prevalence of parasitemia by plasmodium in the population, determined through hemoscopic surveys, and which also classifies the regions as hypoendemic, mesoendemic, hyperendemic and holoendemic if the proportion of infected individuals are \u0026gt;0-10%, 11-50%, 51-75% and \u0026gt;75%, respectively.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThus, a prevalence of 24.2% of malaria was observed in the population, which determined the area as mesoendemic. Therefore, it is necessary to measure the level of endemicity in regular periods in order to evaluate the effectiveness of control activities.\u003c/p\u003e\n\u003cp\u003eIndividuals who reported having some type of symptom at the collection concentrated in the mining and logging areas. In these areas, there were also individuals who did not show any clinical manifestation. Even without evidence that active search for malaria elimination is effective, research indicates that investigations may be more effective as an intervention strategy because they can identify asymptomatic individuals, thus reducing transmission (DA COSTA, 2022; MENDES, 2020). In this sense, further studies should be conducted to clarify the doubts regarding individuals with asymptomatic malaria.\u003c/p\u003e\n\u003cp\u003ePrevalence in the study area occurred more frequently in cassiterite and gold mining locations, which could possibly be related to work activities, since individuals work in endemic areas and do not use preventive measures, thus favoring the transmission of the disease. With respect to the type of use and occupation of the soil, the study area presents the occurrence of malaria cases in regions of deforested areas and/or areas with undergrowth vegetation and sparse trees, since the deforestation for timber extraction and other activities contribute to the occurrence of disease transmission (WYREPKOWSKI, 2021).\u003c/p\u003e\n\u003cp\u003eCorroborating the research, there are studies showing that deforestation, mining areas and also forest remnants, contribute to the occurrence of malaria and the areas with greater wood extraction showed a low incidence of the disease (CHAVES, 2018).\u003c/p\u003e\n\u003cp\u003eIn this scenario, in which the anthropic process is evident, the high environmental modification contributes to the occurrence of cases as presented in this research, which showed that the highest incidence of malaria occurred in mining regions. Other research conducted in areas with similar characteristics, corroborate the results observed in this study, whose authors found that the prevalence of malaria appeared with the creation of mining camps and more frequently in houses near the prospecting zone (LOPES et al, 2019).\u003c/p\u003e\n\u003cp\u003eThe distance of these areas from major health centres may be one of the factors contributing to the concentration of cases, since the delay in seeking care and obtaining the diagnosis to start treatment determines an increase in the transmission period, thus generating a high number of new cases (SILVA et al, 2021).\u003c/p\u003e\n\u003cp\u003eResearch carried out in Mato Grosso found evidence between the occurrence of cases of malaria and prospecting activities, reinforcing the analyses made in this state by other authors (SILVA et al, 2021; LIMA et al, 2022). The proportion of miners with undiagnosed malaria contributes to the collective transmission of the disease, causing a concentration of cases that can evolve into outbreaks of this pathology (LIMA et al, 2022). Hemoscopic investigations are still a great challenge, as it is necessary to have an effective strategy to prevent and control \u003cem\u003eplasmodium\u003c/em\u003e infection, requiring trained individuals to identify the parasite and correctly dispense drugs when diagnosing infected individuals. (EBHUOMA, 2016).\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study allowed concluding that the transmission of malaria in the District of Tr\u0026ecirc;s Fronteiras has a heterogeneous profile along its length, and that the individuals residing in mining, prospecting and timber extraction areas have a higher frequency of infection by plasmodium and that its spatial pattern also has different intensity of distribution of the disease.\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Research Ethics Committee of the University Hospital J\u0026uacute;lio Muller - Federal University of Mato Grosso, approved this study under protocol no. 158.109 of 29 November 2012; CAAE:\u0026nbsp;08500612.3.0000.5541\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analysed during this study are included in this published article [and its supplementary information files].\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that there are no conflicts of interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConselho Nacional de Pesquisa\u003c/em\u003e \u0026ndash; CNPq (National Research Council) (Process 555652/2009-2) and the \u003cem\u003eFunda\u0026ccedil;\u0026atilde;o de Amparo \u0026agrave; Pesquisa do Estado de Mato Grosso\u003c/em\u003e (FAPEMAT) (Research Support State Foundation of Mato Grosso), PRONEX-Network Malaria, Mato Grosso.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCJFF ensured the financing of fieldwork, with resources from PRONEX/\u003cem\u003eRede Mal\u0026aacute;ria\u0026nbsp;\u003c/em\u003e(Malaria Network)/CNPq/FAPEMAT.\u003c/p\u003e\n\u003cp\u003eECO, ESS and PAFJ contributed to the study design, acquisition and interpretation of data, statistical analysis, and writing of the manuscript.\u003c/p\u003e\n\u003cp\u003eESS, MAS and CJFF participated in the study concept, coordination and critical review of the manuscript.\u003c/p\u003e\n\u003cp\u003eACPT, MCPL and ERFL participated in the writing and critical review of the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank the direct and indirect collaborators of this study, in particular to the technicians of the laboratory for malaria diagnosis in the District of Tr\u0026ecirc;s Fronteiras: Ana Cl\u0026eacute;a, Clarice and Rom\u0026aacute;rio Gurgel. We would also like to thank the team of the Master\u0026apos;s Degree in Nursing of the UFMT for contributing in field activities, and the Coordination of Epidemiological Surveillance and the technicians at LACEN-MT and Malaria Laboratory of the University Hospital J\u0026uacute;lio Muller, for their support in the review of the microscopic diagnosis of malaria.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eWorld Health Organisation (WHO), World malaria report 2018. who.int/iris/bitstream/handle/10665/275867/9789241565653-eng.pdf.\u003c/li\u003e\n \u003cli\u003eWorld Health Organization (2022) World Malaria. Geneva, World Health Organization. https://www.paho.org/pt/topicos/malaria.\u003c/li\u003e\n \u003cli\u003eOswaldo Cruz Foundation. [homepage on the Internet]. 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Colniza: Prefeitura Municipal. Dispon\u0026iacute;vel em: http://www.colniza.mt.gov.br/. Acesso em 27 mar\u0026ccedil;o de 2014.\u003c/li\u003e\n \u003cli\u003eC\u0026acirc;mara, Gilberto, et al. \u0026quot;An\u0026aacute;lise espacial e geoprocessamento.\u0026quot; An\u0026aacute;lise espacial de dados geogr\u0026aacute;ficos. Bras\u0026iacute;lia: EMBRAPA (2004): 21-54. https://portalidea.com.br/cursos/bsico-em--anlise-espacial-de-dados-geogrficos-apostila02.pdf. Acesso de junho de 2014\u003c/li\u003e\n \u003cli\u003eSousa, Jessica de Oliveira. Diversidade gen\u0026eacute;tica de Plasmodium vivax em uma \u0026aacute;rea de alta endemicidade para mal\u0026aacute;ria no m\u0026eacute;dio Rio Negro, Amazonas, Brasil. Diss. 2020. https://www.arca.fiocruz.br/handle/icict/47377.\u003c/li\u003e\n \u003cli\u003eRodrigues, Danielle Fonseca. Caracteriza\u0026ccedil;\u0026atilde;o molecular das recidivas de Plasmodium vivax ap\u0026oacute;s tratamento com ACT: Estudo de polimorfismos relacionados \u0026agrave; resist\u0026ecirc;ncia do parasito e metabolismo alterado de CYP2D6. Diss. 2020. https://www.arca.fiocruz.br/handle/icict/48369.\u003c/li\u003e\n \u003cli\u003eSilvino, Ana Carolina Rios. Recorr\u0026ecirc;ncias na mal\u0026aacute;ria por Plasmodium vivax: variabilidade na enzima do complexo citocromo P450 2D6 (CYP2D6) e sua influ\u0026ecirc;ncia na falha terap\u0026ecirc;utica por primaquina. Diss. 2019. https://www.arca.fiocruz.br/handle/icict/35371.\u003c/li\u003e\n \u003cli\u003eMakanjuola, Rasheed O., and Andrew W. Taylor-Robinson. \u0026quot;Improving accuracy of malaria diagnosis in underserved rural and remote endemic areas of sub-Saharan Africa: a call to develop multiplexing rapid diagnostic tests.\u0026quot; Scientifica 2020 (2020). https://www.hindawi.com/journals/scientifica/2020/3901409/.\u003c/li\u003e\n \u003cli\u003eDa Costa Fonseca, Erique, et al. \u0026quot;A Fronteira internacional e a dissemina\u0026ccedil;\u0026atilde;o das doen\u0026ccedil;as dengue, mal\u0026aacute;ria, zika e chicungunya.\u0026quot; \u003cem\u003eRevista Portuguesa de Ci\u0026ecirc;ncias e Sa\u0026uacute;de\u003c/em\u003e 3.01 (2022): 31-43. https://www.revistas.editoraenterprising.net/index.php/rpcs/article/view/470.\u003c/li\u003e\n \u003cli\u003eMendes, Maria Beatriz Gomes. \u0026quot;Estudo do programa de preven\u0026ccedil;\u0026atilde;o e controle da mal\u0026aacute;ria no estado do Amap\u0026aacute; diante da meta de elimina\u0026ccedil;\u0026atilde;o at\u0026eacute; 2035.\u0026quot; (2020). https://app.uff.br/riuff/handle/1/23174.\u003c/li\u003e\n \u003cli\u003eWyrepkowski, Claudia Dantas Comandolli, et al. \u0026quot;Registro de casos de mal\u0026aacute;ria na \u0026uacute;ltima d\u0026eacute;cada em Manaus, Amazonas, Amaz\u0026ocirc;nia Brasileira.\u0026quot; \u003cem\u003eBrazilian Journal of Development\u003c/em\u003e 7.1 (2021): 9592-9600. https://ojs.brazilianjournals.com.br/ojs/index.php/BRJD/article/view/23731\u003c/li\u003e\n \u003cli\u003eChaves, L. S. M. (2018). \u003cem\u003eSistema ecol\u0026oacute;gico da mal\u0026aacute;ria\u003c/em\u003e (Doctoral dissertation, Universidade de S\u0026atilde;o Paulo). https://www.teses.usp.br/teses/disponiveis/6/6132/tde-07032019-130741/en.php.\u003c/li\u003e\n \u003cli\u003eLopes, Thalyta Mariany R\u0026ecirc;go, et al. \u0026quot;Situa\u0026ccedil;\u0026atilde;o epidemiol\u0026oacute;gica da mal\u0026aacute;ria em uma regi\u0026atilde;o de Garimpo, na regi\u0026atilde;o da Amaz\u0026ocirc;nia brasileira, no per\u0026iacute;odo de 2011 a 2015.\u0026quot; \u003cem\u003eRevista Eletr\u0026ocirc;nica Acervo Sa\u0026uacute;de\u003c/em\u003e 25 (2019): e759-e759. https://acervomais.com.br/index.php/saude/article/view/759.\u003c/li\u003e\n \u003cli\u003eAnjos-Silva, Jessica Tailane, et al. \u0026quot;Surto de mal\u0026aacute;ria em \u0026aacute;rea de minera\u0026ccedil;\u0026atilde;o situada no Vale do Rio Jequitinhonha, Estado de Minas Gerais: Malaria outbreak in a mining area located in the Jequitinhonha River Valley, State of Minas Gerais.\u0026quot; \u003cem\u003eHealth and Biosciences\u003c/em\u003e 2.2 (2021): 29-37. https://scholar.archive.org/work/ql5xtrrwindyvidsljmcupzl2y/access/wayback/https://periodicos.ufes.br/healthandbiosciences/article/download/35132/23853\u003c/li\u003e\n \u003cli\u003eLima, Ana Elisa Oliveira, Assis do Carmo Pereira J\u0026uacute;nior, and Rosana Passos Cambraia. \u0026quot;Caracteriza\u0026ccedil;\u0026atilde;o epidemiol\u0026oacute;gica do surto de mal\u0026aacute;ria na regi\u0026atilde;o do garimpo Areinha, Alto Vale do Jequitinhonha, Minas Gerais, Brasil.\u0026quot; \u003cem\u003eResearch, Society and Development\u003c/em\u003e 11.12 (2022): e119111234236-e119111234236. https://rsdjournal.org/index.php/rsd/article/view/34236\u003c/li\u003e\n \u003cli\u003eEbhuoma, Osadolor e Michael Gebreslasie. \u0026quot;Vari\u0026aacute;veis clim\u0026aacute;ticas/ambientais baseadas em sensoriamento remoto para modelar a transmiss\u0026atilde;o da mal\u0026aacute;ria na \u0026Aacute;frica Subsaariana.\u0026quot; Jornal internacional de pesquisa ambiental e sa\u0026uacute;de p\u0026uacute;blica 13.6 (2016): 584. https://www.mdpi.com/143898\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"malaria-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"malj","sideBox":"Learn more about [Malaria Journal](http://malariajournal.biomedcentral.com/)","snPcode":"12936","submissionUrl":"https://submission.nature.com/new-submission/12936/3","title":"Malaria Journal","twitterHandle":"@malariajournal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"malaria, spatial analysis, epidemiology","lastPublishedDoi":"10.21203/rs.3.rs-2749203/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2749203/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eMore than 95% of malaria transmission in Brazil occurs in the region called Legal Amazon constituted among other Brazilian states, including Mato Grosso, where, in 2015, 54% of the cases occurred in the municipality of Colniza, in the northwestern region of the state.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eObjetive: To describe the epidemiological profile of malaria in a rural community in the northwestern region of Mato Grosso, emphasizing its spatial pattern of occurrence.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMethods: This is an ecological study covering information on the prevalence of plasmodium infection and on the use and occupation of soil by the population of the Três Fronteiras District, in the municipality of Colniza, Mato Grosso. Data were collected through a home visit in July 2011, with blood collection from the digital pulp for the preparation of a thick smear slide, completion of the SIVEP_Malaria notification form, for the construction of a georeferenced database with the software ArcGIS 9.2 (ESRI Corp.). The information was divided into use and occupation classes. In TerraView 3.14, a Kernel map was built to verify the density of cases and their location.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResults: Of the 621 respondents, 68(11%) had plasmodium infection, 39(57.4%) of them by P. vivax, 27(39.7%) by P. falciparum and two (2.9%) with mixed infection. Among infected individuals, 49(72.1%) were men and 19(27.9%), women. The distribution of prevalent cases of infection by overlaying the map of occupation and use of land showed that the cases of malaria are distributed over the entire length of the district, with greater occurrence of cases per household in open areas, close to the mining company/artisanal mining. The kernel method, from the characterization of the spatial distribution pattern of malaria cases, allowed identifying areas of greater intensity of cases, whose so-called “hot” areas were located in the gold mining region.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConclusion: The transmission of malaria in the district of Três Fronteiras has a heterogeneous profile along its length, and the individuals residing in areas of mining, artisanal mining and timber extraction has increased frequency of infection by plasmodium, and its spatial pattern has a difference in the intensity of distribution of the disease.\u003c/p\u003e","manuscriptTitle":"Epidemiological Profile of Malaria in a Rural Community From the Amazon of Mato Grosso","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-03-30 18:19:37","doi":"10.21203/rs.3.rs-2749203/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2023-06-05T16:41:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-04-21T16:13:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"52130136-bc3a-4218-8788-c23af6717b39","date":"2023-03-31T14:06:58+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2023-03-31T13:36:11+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2023-03-29T09:47:43+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2023-03-29T09:47:43+00:00","index":"","fulltext":""},{"type":"submitted","content":"Malaria Journal","date":"2023-03-29T00:51:24+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"malaria-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"malj","sideBox":"Learn more about [Malaria Journal](http://malariajournal.biomedcentral.com/)","snPcode":"12936","submissionUrl":"https://submission.nature.com/new-submission/12936/3","title":"Malaria Journal","twitterHandle":"@malariajournal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"006d0c72-b0fc-4133-a398-6a73327cc4db","owner":[],"postedDate":"March 30th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-08-12T16:04:32+00:00","versionOfRecord":{"articleIdentity":"rs-2749203","link":"https://doi.org/10.1186/s12936-024-05033-7","journal":{"identity":"malaria-journal","isVorOnly":false,"title":"Malaria Journal"},"publishedOn":"2024-08-05 15:57:48","publishedOnDateReadable":"August 5th, 2024"},"versionCreatedAt":"2023-03-30 18:19:37","video":"","vorDoi":"10.1186/s12936-024-05033-7","vorDoiUrl":"https://doi.org/10.1186/s12936-024-05033-7","workflowStages":[]},"version":"v1","identity":"rs-2749203","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2749203","identity":"rs-2749203","version":["v1"]},"buildId":"-HB7Z8yhvgn0wM9Nzuekk","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}