Fig. 4

Box-and-whisker plot summarizing the distribution over time of annual local or indigenous case counts across all countries for which time series were identified. The box represents the interquartile range with line showing median, while whiskers indicate maximum and minimum values within 1.5× of the interquartile range and dots outliers beyond this range. Box width is proportionate to the sample size for that year. The red line shows a linear fit segmented at the statistically significant breakpoint calculated for the combined series