CLIMATE AND LAND USE DRIVERS OF THE SPATIAL AND TEMPORAL DISTRIBUTION OF MALARIA RISK IN THE PERUVIAN AMAZON, 2001-2011

Malaria remains one of the world's most devastating public health threats. In Peru, 75% of malaria occurs in the northern Amazon region of Loreto where 80% of cases are concentrated in just 10 districts. To achieve and sustain low malaria rates, better knowledge of where, when and why people are infected is needed. A key factor affecting malaria endemicity in Loreto is vector habitat expansion from land use change, and social and ecological processes that increase human exposure. Coupled with this, changes related to climate, including rainfall and flooding, temperature, humidity and soil moisture are all also linked to the growth and survival of both the parasite (Plasmodium sp.) and the dominant mosquito vector in the Amazon, Anopheles darlingi. To refine and focus prevention strategies, spatially explicit risk estimates are necessary. In this study, we investigate how malaria risk varies across time and space in Loreto by modeling the relationship among meteorology, hydrology, land use, and malaria from 2001 to 2012. Meteorological information was drawn from climate reanalyses and satellite-derived precipitation products, hydrology was simulated using a Land Data Assimilation System that integrated a range of satellite observations into the Noah Land Surface Model, and land use was drawn from Landsat-informed analyses. Using a poison random effects model, we incorporate annual measures of land use, spatial ecology, and weekly hydrometeorological variables with weekly surveillance data reported from 356 government health posts in 51 districts of the region of Loreto between 2001 and 2011. We are testing the validity of this model with data from 2012. Initial models indicate increased malaria rates in areas with higher (lagged) rainfall and soil moisture as well as areas prone to flood. These models will be compared against current forecasting methods to determine if more efficient prevention and control efforts can be implemented.