# Spatiotemporal Analysis of Malaria Transmission in the Autonomous Indigenous Regions of Panama, Central America, 2015–2022

## TL;DR

Malaria cases have sharply increased in Panama's indigenous regions from 2015 to 2022, with clusters found in specific villages.

## Contribution

The study identifies spatiotemporal malaria clusters in Panama's indigenous regions and explores contributing factors.

## Key findings

- Malaria cases are clustered in indigenous villages in Ngäbe–Buglé, Guna Yala, and Embera regions.
- The increase in cases is linked to migration, poor health services, and lack of culturally sensitive tools.
- Transmission hotspots are located near the eastern border with Colombia.

## Abstract

Despite ongoing efforts for elimination, malaria continues to be a major public health problem in the Republic of Panama. For effective elimination, it is key that malaria foci and areas of high transmission are identified in a timely manner. Here, we study malaria transmission records for the 2015–2022 period, a time when cases have increased by a factor of ten. Using several methods to study spatial and spatiotemporal malaria confirmed case clusters at the level of localities, including LISA and scan, we found that cases are clustered across indigenous villages located within the autonomous indigenous regions of Ngäbe–Buglé, Guna Yala, and Embera, with the latter on the eastern border of Panama (with Colombia). We discuss the different factors that might be shaping the marked increase in malaria transmission associated with these clusters, which include an inflow of malaria-exposed migrating populations hoping to reach the USA, insufficient health services, and the lack of culturally sensitive actionable tools to reduce malaria exposure among the ethnically diverse and impoverished indigenous populations of Panama.