Malaria journal · 2026
Spatio-temporal heterogeneity of urban malaria in Libreville, Gabon (2012-2023): neighborhood-level hotspot analysis for micro-stratified control.
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Mohamed-Djawad Mohamed Hassani, Moutombi Ditombi Bridy Chesly, Ndong Ngomo Jacques Mari, Mbang Nguema Ornella Anaïse, Agbanrin Ahmed Adissa, Pongui Ngondza Bedrich, Kono Héléna Noéline, Nymane Tatiana, Ombago Joinito, Migueba Valentin, James Luice Aurtin Joël, Moussavou Mabicka Dimitri Ardin, Mihindou Coëlla Joyce, Ndong Akomezoghe Luccheri, Ndong Mouity Joël Tobie, Mawili-Mboumba Denise Patricia, Bouyou-Akotet Marielle Karine, M'Bondoukwé Noé Patrick
Аннотация
BACKGROUND: In Libreville, Gabon, the Melen sentinel site has monitored malaria among febrile children for over a decade, offering a lens on intra-urban transmission. We aimed to characterize neighborhood-level spatial and temporal dynamics (2012-2023) and identify high-risk areas for micro-stratified control.
METHODS: Geographic and parasitological data from 9,507 children (Jan 2012-Dec 2023) were analyzed. Diagnosis used standard microscopy (thick/thin smears). Plasmodium falciparum prevalence (PfPR) was calculated for 44 neighborhoods across four periods. Neighborhoods were classified by adapted WHO endemicity thresholds and grouped into socio-spatial categories (urban, semi-urban, shanty-town, semi-rural). Global spatial autocorrelation was tested with Moran's I, then local Getis-Ord Gi* identified hotspots and coldspots.
RESULTS: By category, PfPR in 2023 was highest in semi-rural areas (50.9%, 95% CI: 47.9-54.0) and semi-urban areas (46.5%, 95% CI: 43.8-49.3), followed by shanty-town areas (44.6%, 95% CI: 42.6-46.6) and urban areas (38.0%, 95% CI: 33.1-43.2). Substantial within-category heterogeneity was observed, with neighbourhoods within the same socio-spatial class exhibiting markedly different PfPR during the same period. The WHO classification showed a shift from mostly mesoendemic neighbourhoods in 2015 to 41.5% hyperendemic neighbourhoods in 2023. The Gi* hotspot analysis (k = 4) identified significant clusters that changed over time: hotspots were detected in semi-urban and semi-rural neighbourhoods in 2012-2013 and 2015-2016, shifted towards semi-rural neighbourhoods in 2018-2019 (with coldspots emerging in shanty-town settings), and re-emerged in both semi-urban and semi-rural strata in 2023, with a coldspot detected in a shanty-town neighbourhood.
CONCLUSIONS: Malaria transmission in Libreville is highly heterogeneous and dynamic, with predominant mesoendemic neighborhoods and recurrent hotspots. Findings support micro-stratified strategies prioritizing recurrent clusters and integrating fine-scale spatial analytics into national surveillance.
METHODS: Geographic and parasitological data from 9,507 children (Jan 2012-Dec 2023) were analyzed. Diagnosis used standard microscopy (thick/thin smears). Plasmodium falciparum prevalence (PfPR) was calculated for 44 neighborhoods across four periods. Neighborhoods were classified by adapted WHO endemicity thresholds and grouped into socio-spatial categories (urban, semi-urban, shanty-town, semi-rural). Global spatial autocorrelation was tested with Moran's I, then local Getis-Ord Gi* identified hotspots and coldspots.
RESULTS: By category, PfPR in 2023 was highest in semi-rural areas (50.9%, 95% CI: 47.9-54.0) and semi-urban areas (46.5%, 95% CI: 43.8-49.3), followed by shanty-town areas (44.6%, 95% CI: 42.6-46.6) and urban areas (38.0%, 95% CI: 33.1-43.2). Substantial within-category heterogeneity was observed, with neighbourhoods within the same socio-spatial class exhibiting markedly different PfPR during the same period. The WHO classification showed a shift from mostly mesoendemic neighbourhoods in 2015 to 41.5% hyperendemic neighbourhoods in 2023. The Gi* hotspot analysis (k = 4) identified significant clusters that changed over time: hotspots were detected in semi-urban and semi-rural neighbourhoods in 2012-2013 and 2015-2016, shifted towards semi-rural neighbourhoods in 2018-2019 (with coldspots emerging in shanty-town settings), and re-emerged in both semi-urban and semi-rural strata in 2023, with a coldspot detected in a shanty-town neighbourhood.
CONCLUSIONS: Malaria transmission in Libreville is highly heterogeneous and dynamic, with predominant mesoendemic neighborhoods and recurrent hotspots. Findings support micro-stratified strategies prioritizing recurrent clusters and integrating fine-scale spatial analytics into national surveillance.