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Background  In a malaria-endemic area the distribution of patients is neither constant in time nor homogeneous in space. The WHO recommends the stratification of malaria risk on a fine geographical scale. In the village of Cacao in French Guiana, the study of the spatial and temporal distribution of malaria cases, during an epidemic, allowed a better understanding of the environmental factors promoting malaria transmission.    Methods  A dynamic cohort of 839 persons living in 176 households (only people residing permanently in the village) was constituted between January1st, 2002 and December 31st, 2007.  The information about the number of inhabitants per household, the number of confirmed cases of  Plasmodium vivax  and house GPS coordinates were collected to search for spatial or temporal clustering using Kurlldorff’s statistical method.    Results  Of the 839 persons living permanently in the village of Cacao, 359 persons presented at least one vivax malaria episode between 2002 and 2007. Five temporal clusters and four spatial clusters were identified during the study period. In all temporal clusters, April was included. Two spatial clusters were localized at the north of the village near the Comté River and two others localized close to orchards.    Conclusion  The spatial heterogeneity of malaria in the village may have been influenced by environmental disturbances due to local agricultural policies: deforestation, cultures of fresh produce, or drainage of water for agriculture. This study allowed generating behavioural, entomological, or environmental hypotheses that could be useful to improve prevention campaigns.

Deforestation, agriculture and farm jobs: a good recipe for Plasmodium vivax in French Guiana