Effect of out-of-village working activities on recent malaria exposure in the Peruvian Amazon using parametric g-formula.
Gabriel Carrasco-Escobar, Jason Rosado, Oscar Nolasco, Michael T White, Ivo Mueller, Marcia C Castro, Hugo Rodriguez-Ferruci, Dionicia Gamboa, Alejandro Llanos-Cuentas, Joseph M Vinetz, Tarik Benmarhnia
Author Information
Gabriel Carrasco-Escobar: Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA. gabriel.carrasco@upch.pe.
Jason Rosado: G5 Épidémiologie Et Analyse Des Maladies Infectieuses, Département de Santé Globale, Institut Pasteur, 75015, Paris, France.
Oscar Nolasco: Instituto de Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.
Michael T White: G5 Épidémiologie Et Analyse Des Maladies Infectieuses, Département de Santé Globale, Institut Pasteur, 75015, Paris, France.
Ivo Mueller: Department of Medical Biology, University of Melbourne, Melbourne, Victoria, Australia.
Marcia C Castro: Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Hugo Rodriguez-Ferruci: Universidad Nacional de La Amazonía Peruana, Loreto, Peru.
Dionicia Gamboa: Instituto de Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.
Alejandro Llanos-Cuentas: Instituto de Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.
Joseph M Vinetz: Instituto de Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.
Tarik Benmarhnia: Scripps Institution of Oceanography, University of California, San Diego, CA, 92037, USA.
In the Amazon Region of Peru, occupational activities are important drivers of human mobility and may increase the individual risk of being infected while contributing to increasing malaria community-level transmission. Even though out-of-village working activities and other mobility patterns have been identified as determinants of malaria transmission, no studies have quantified the effect of out-of-village working activities on recent malaria exposure and proposed plausible intervention scenarios. Using two population-based cross-sectional studies in the Loreto Department in Peru, and the parametric g-formula method, we simulated various hypothetical scenarios intervening in out-of-village working activities to reflect their potential health benefits. This study estimated that the standardized mean outcome (malaria seroprevalence) in the unexposed population (no out-of-village workers) was 44.6% (95% CI: 41.7%-47.5%) and 66.7% (95% CI: 61.6%-71.8%) in the exposed population resulting in a risk difference of 22.1% (95% CI: 16.3%-27.9%). However, heterogeneous patterns in the effects of interest were observed between peri-urban and rural areas (Cochran's Q test = 15.5, p < 0.001). Heterogeneous patterns were also observed in scenarios of increased prevalence of out-of-village working activities and restriction scenarios by gender (male vs. female) and age (18 and under vs. 19 and older) that inform possible occupational interventions targetting population subgroups. The findings of this study support the hypothesis that targeting out-of-village workers will considerably benefit current malaria elimination strategies in the Amazon Region. Particularly, males and adult populations that carried out out-of-village working activities in rural areas contribute the most to the malaria seropositivity (recent exposure to the parasite) in the Peruvian Amazon.
Associated Data
figshare | 10.6084/m9.figshare.19802116.v1
References
Am J Epidemiol. 2013 May 1;177(9):989-96
[PMID: 23558355]
