Predicting risk of imported disease with demographics: Geospatial analysis of imported malaria in Minnesota, 2010-2014

Malaria remains an important health concern among U.S. travelers, particularly within sub-Saharan African (SSA) immigrant and refugee communities who make up the highest burden proportion of travelers visiting friends and relatives (VFR).1 Strategies to reduce the disease burden in this population have previously centered on identifying barriers to preventive care,2–5 culturally sensitive risk communication,2,6 as well as medical provider knowledge and practice.7–9 Furthermore, malaria prevention strategies and interventions have been more broad-based in the scope of information provided and intended audience rather than tailored to high-risk populations such as VFRs.10 Existing interventions have largely taken a top-down approach without solid understanding of knowledge, attitudes, and practices (KAP) of groups at greatest risk. Furthermore, there are limited data on the effectiveness of existing prevention strategies at the population level. This study reflects initial results from one line of effort within a larger multisite and multidisciplinary prevention study funded by the Centers for Disease Control and Prevention. Minnesota has a large, diverse immigrant and refugee population and ranks in the top 10 states for absolute number of malaria cases.11,12 A tradition of robust health engagement in refugee and immigrant populations makes Minnesota an ideal state for assessing the impact of malaria interventions in high-risk communities (http://www.health.state.mn.us/divs/idepc/refugee/). An important first step toward addressing gaps in prevention for VFRs, this study leverages disease surveillance and open source census data to develop a model that can be adapted by researchers or health departments to other contexts to anticipate risk, target prevention efforts, and measure impact.13