Spatial patterns of malaria in the Amazon: implications for surveillance and targeted interventions.

A measure of local spatial association, G(i)*(d), is applied to test for the presence of malaria clusters in a colonization area in the Brazilian Amazon. Clusters of high and low malaria rates at different moments in time are identified. They suggest unambiguous spatial patterns of transmission, most likely linked to the social and natural habitat. Results imply that a comprehensive identification of the determinants of malaria transmission requires a spatial framework of analysis, and that control strategies must be spatially targeted and guided by a surveillance system that constantly learns the specificities of local transmission and adapts interventions to them.