{ "abstract": "Background: As transmission declines, malaria becomes more spatially and demographically concentrated. This study investigated individual-level malaria characteristics and district-level factors associated with elimination in all 154 districts in Sumatra, Indonesia.\n\nMethods: We analysed individual-level data of 13,386 reported malaria cases from 2019 to 2021. P. falciparum and P. vivax were confirmed by microscopy or rapid diagnostic test, while probable P. knowlesi was defined as microscopically identified P. knowlesi. Cases were classified as imported if they reported travel to endemic region within 2–4 weeks. Multivariable logistic regression with province as a random effect was used to examine individual-level factors associated with imported cases, and district-level socioeconomic and environmental factors associated with elimination. Spatial clustering of indigenous cases was assessed using Global Moran’s I and SaTScan.\n\nResults: Among reported cases, 71.8% (9,617) were P. vivax, 18.4% (2,467) P. falciparum, and 2.8% (369) probable P. knowlesi. Of 11,390 investigated cases, 8,748 (76.8%) were indigenous, 1,741 (15.3%) imported, and 901 (7.9%) unclassified. Imported cases were associated with older age (adjusted odds ratio 1.79, 95%CI 1.42–2.25 for 15–24 years old, and 1.97, 1.59–2.46 for 25–64 years old, compared to < 15 years old), males (1.70, 1.43–2.03), mobile and migrant population-related occupations (1.46, 1.22–1.76), diagnosed at hospitals or clinics (2.32, 1.85–2.91), infected with P. falciparum (1.48, 1.22–1.80), and hospitalised (15.29, 12.66–18.46). At the district level, a higher human development index (1.15, 1.01–1.34), lower historical annual parasite incidence (0.46, 0.29–0.69), and fewer endemic neighbours (0.78, 0.67–0.89) were associated with a higher likelihood of elimination. Spatial analysis revealed clustering tendencies, with localised clusters for P. falciparum, P. vivax, and probable P. knowlesi.\n\nConclusions: Dynamics of imported malaria, heterogeneous clusters of local transmission, and lower district-level human development index challenged elimination efforts. This highlights the need for strengthened surveillance and targeted interventions.\n\nSupplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12916-026-05104-3.", "abstract_shown": true, "affiliations": [ "Oxford University Clinical Research Unit Indonesia, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia", "Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand", "Infectious and Tropical Diseases Epidemiology, Public Health Program, Monash University Indonesia, Tangerang, Indonesia", "Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore", "Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK", "Malaria Working Group, Ministry of Health, Jakarta, Indonesia", "World Health Organisation, Country Office for Indonesia, Jakarta, Indonesia", "Centre for Online Health, Medical School, Faculty of Health, Medicine and Behavioural Sciences, The University of Queensland, Brisbane, QLD Australia", "Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia", "Mahidol Oxford Tropical Medicine Research Unit (MORU), Bangkok, Thailand" ], "article_type": "research article", "arxiv": null, "author_total": 15, "authors": [ { "affs": [ 0, 1 ], "name": "Karina D Lestari", "orcid": "0000-0001-6225-3474" }, { "affs": [ 0, 2 ], "name": "Henry Surendra", "orcid": "0000-0002-6029-0623" }, { "affs": [ 0, 3 ], "name": "Bimandra A Djaafara", "orcid": "0000-0001-7481-2624" }, { "affs": [ 0, 4 ], "name": "Ihsan Fadilah", "orcid": "0000-0001-9507-6427" }, { "affs": [ 0 ], "name": "Lenny L Ekawati", "orcid": "0000-0002-6962-5565" }, { "affs": [ 5 ], "name": "Hermawan Susanto" }, { "affs": [ 5 ], "name": "Hellen D Prameswari" }, { "affs": [ 1, 5 ], "name": "Sri B Fajariyani" }, { "affs": [ 5 ], "name": "Dedy Supriyanto" }, { "affs": [ 6, 7 ], "name": "Herdiana Herdiana", "orcid": "0000-0002-7260-3682" }, { "affs": [ 8 ], "name": "Eamon Conway", "orcid": "0000-0002-8807-4877" }, { "affs": [ 1 ], "name": "Pimphen Charoen", "orcid": "0000-0001-8851-0520" }, { "affs": [ 1 ], "name": "Saranath Lawpoolsri", "orcid": "0000-0003-4841-7924" }, { "affs": [ 1, 9 ], "name": "Wirichada Pan-ngum", "orcid": "0000-0002-9839-5359" }, { "affs": [ 0, 2 ], "name": "Iqbal R F Elyazar", "orcid": "0000-0003-3115-5059" } ], "bibtex": "https://research.draconitic.com/paper/78c4a3j52qwav.bib", "cited_by": 1, "doi": "10.1186/s12916-026-05104-3", "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13711844/", "id": "78c4a3j52qwav", "issns": [ "1741-7015" ], "landing_url": "https://doi.org/10.1186/s12916-026-05104-3", "language": "en", "licence": "CC-BY-4.0", "licence_label": "CC BY 4.0", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "heading", "Research" ], [ "openalex", "2739|Malaria Research and Control" ] ], "openalex": "W4413924794", "pdf_url": null, "pmcid": "PMC13711844", "pmid": "42934639", "published": "2026-07-29", "publisher": "BMC", "ris": "https://research.draconitic.com/paper/78c4a3j52qwav.ris", "sources": [ { "first_seen": "2026-10-31T12:22:33Z", "native_id": "PMC13711844", "source": "pmc", "url": "https://doi.org/10.1186/s12916-026-05104-3" } ], "subjects": [ { "field": "medicine", "origin": "openalex:2739|Malaria Research and Control", "subfield": "epidemiology-public-health" } ], "title": "Epidemiology of malaria and district-level factors associated with malaria elimination in Sumatra region, Indonesia: a retrospective analysis of surveillance data", "title_text": "Epidemiology of malaria and district-level factors associated with malaria elimination in Sumatra region, Indonesia: a retrospective analysis of surveillance data", "type": "peer-reviewed", "updated_at": "2026-10-31T12:22:33Z", "url": "https://research.draconitic.com/paper/78c4a3j52qwav", "venue": "BMC Medicine", "versions": [] }