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Malaria Journal

Open Access

The spatial-temporal clustering of Plasmodium falciparum infection over eleven years in Gezira State, The Sudan

  • Samia E Mirghani1,
  • Bakri YM Nour1,
  • Sayed M Bushra1,
  • Ibrahim El Hassan2,
  • Robert W Snow3, 4 and
  • Abdisalan M Noor3, 4
Malaria Journal20109(Suppl 2):P22

Published: 20 October 2010


MalariaMalaria TransmissionMalaria EliminationBernoulli ModelPlasmodium Falciparum Infection


Malaria infection and disease exhibit microgeographic heterogeneity which if predictable could have implications for designing small area intervention. Here we investigate the space-time clustering of Plasmodium falciparum infections using data from repeat cross-sectional surveys in Gezira State, a low transmission area in northern Sudan.


Data from cross-sectional surveys undertaken in January each year from 1999-2009 in 88 villages in the Gezira state were assembled. During each survey, about a 100 children between the ages 2 to1 0 years were sampled to examine the presence of P. falciparum parasites. In 2009, all the villages were mapped using global positioning systems. Cluster level data were analysed for spatial-only and space-time clustering using the Bernoulli model and the significance of clusters were tested using the Kulldorff scan statistic.


Over the study period, 96,022 malaria slide examinations were undertaken and the P. falciparum prevalence was 8.6% in 1999 and by 2009 this had reduced to 1.6%. The cluster analysis showed the presence of one significant spatial-only cluster in each survey year and one significant space-time cluster over the whole study period. The primary spatial-only clusters in 10/11 years were either contained within or overlapped with the primary space-time cluster.


The results of the study confirm the generally low malaria transmission in the state of Gezira and the presence of spatial and space-time clusters concentrated around a specific area in the south of the state. Improved surveillance data that allows for the analysis of seasonality, age and other risk factors need to be collected to design effective small area interventions as Gezira states targets malaria elimination.

Authors’ Affiliations

Blue Nile National Institute for Communicable Diseases, University of Gezira, Wad-Medani, Sudan
Institute of Endemic Diseases, Department of Parasitology and Molecular Epidemiology, University of Khartoum, Sudan
Malaria Public Health and Epidemiology Group, Centre for Geographic Medicine, KEMRI-University of Oxford - Wellcome Trust Collaborative Programme, Kenyatta National Hospital Grounds (behind NASCOP), Nairobi, Kenya
Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, CCVTM, Oxford, UK


© Mirghani et al; licensee BioMed Central Ltd. 2010

This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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