COMPARATIVE ANALYSIS OF THE GEOGRAPHIC DISTRIBUTION OF MALARIA IN TERAI DISTRICTS OF NEPAL

Approximately 22.8 million people live in malaria risk areas in Nepal. Malaria has been reported in 65 out of 75 districts of Nepal. Biophysically, the country is divided into three major physiographic regions based on the altitudinal gradient. The physiography of the country plays an important role in malaria distribution. Therefore, we have chosen to conduct our research in Nepal as it provides a range of socioeconomic and public health conditions against the background of biophysical environments suitable for malaria transmission. The socioeconomic status of the population of Nepal varies from highly affluent to a significant portion of the population living below the poverty line. There is a significant geographic difference in availability and access to health care facilities. The medical services are concentrated in population centers. There has been a considerable fluctuation in malaria cases in the last couple of decades. There are multiple factors contributing to this fluctuation such as development of resistance to commonly used insecticides, inaccessibility of malarial focal areas due to a lack of infrastructure, deforestation and migration. Massive deforestation in Southern Nepal to accommodate the influx of people to the Terai created a favorable environment for malaria reemergence. Deforestation, internal migration from hills to Terai, and seasonal migration to India has together contributed significantly to malaria resurgence in Nepal.

This study attempts to identify the intra regional difference in geographic distribution of malaria taking an example from 3 districts from the Terai region of Nepal. We propose a methodology that integrates biophysical, socioeconomic and public-health factors which are known to influence malaria. We use a spatial hierarchical approach, assuming that each of the above mentioned factors operates at different spatial scales. We will present the summary of the results from the pilot study to provide an overview of our research.