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Spatial dependence of malaria epidemics in municipalities of the Amazonian Ecosystem.

INTRODUCTION
In 2010, there were 305 (37.8%) municipalities with malaria epidemics in the Brazilian Amazon. The epidemics spread can be explained by the spatial distribution pattern.


OBJECTIVE
To analyze the spatial dependence, autocorrelation, of the malaria epidemics in the municipalities of this region.


METHODS
An automated algorithm was used for the detection of epidemic municipalities in 2003, 2007 and 2010. Spatial dependence was analyzed by applying the global and local Moran index on the epidemic months proportion variable. The epidemic municipalities clusters were identified using the TerraView software.


RESULTS
The global Moran index values were 0.4 in 2003; 0.6 in 2007; and 0.5 in 2010 (p = 0.01), confirming the spatial dependence among the epidemic municipalities. Box Map and Moran Map identified inter-municipal, interstate and borders clusters with spatial autocorrelation (p < 0.05). There were 10 epidemic municipalities clusters in 2003; 9 in 2007 and 8 in 2010.


DISCUSSION
The epidemic municipalities clusters may be linked to the health facilities difficulties on acting together. The structural limitations of the health services can be overcome by territorial integration to support planning and control activities, strengthening the interventions.


CONCLUSION
The routine analysis of the epidemic municipalities clusters with spatial and temporal persistence may provide a new indicator of planning and integrated control prioritization, contributing to malaria epidemics reducing in inter-municipal, interstate and borders areas.