Spatial-temporal Distribution and Demography of Knowlesi Malaria in Peninsular Malaysia, 2011 to 2018

Background: The life-threatening zoonotic malaria caused by Plasmodium knowlesi is on the rise in Malaysia; however, previous studies mainly focus on the transmission in Malaysian Borneo. This study aims to describe the basic epidemiological characteristics of P. knowlesi infection and identify spatial clustering of knowlesi malaria in Peninsular Malaysia. Methods : The spatial distribution of P. knowlesi monoinfection incidence was mapped across Peninsular Malaysia using Geographic Information System (GIS) approach. Demographic characteristics of the infection was investigated. Global and Local Moran’s I were used to analyze spatial autocorrelation and define clustering of knowlesi malaria incidence. Results : Gua Musang and Lipis maintained the highest incidence rate (IR) as compared to other districts. Spatial analysis revealed that high IRs (hotspots) were clustered in the central-northern region of Peninsular Malaysia. In the demographic aspect, knowlesi malaria was more prevalent in male and age between 20 and 39. Conclusions : This study revealed the spatial and temporal patterns of P. knowlesi in Peninsular Malaysia throughout 2011 to 2018. Knowlesi malaria control strategy should be emphasized in Malaysia malaria eradication program.