Determinants of malaria from environmental and poverty aspects in Indonesia: A spatiotemporal perspective, 2016-2020

Objective:
To investigate the environmental and social aspects of poverty contributing to malaria incidence in Indonesia from 2016 to 2020.

Methods:
Random forest regression was used to analyse the independent variables contributing to malaria incidence. Environmental conditions were extracted from remotely sensed data, including vegetation, land temperature, soil moisture, precipitation, and elevation. In contrast, the social aspects of poverty were obtained from government statistical reports.

Results:
From 2016 to 2020, the contribution of each environmental and social aspect of poverty to malaria incidence fluctuated annually. Generally, the top three essential variables were people aged 15 years and above, experiencing poverty (variable importance/VI=32.0%), people experiencing poverty who work in the agricultural sector (VI=14.4%), and precipitation (VI=9.8%). It was followed by people experiencing poverty who are unemployed (VI=9.2%), land temperature (VI=5.2%), people experiencing poverty who have low education (VI=8.0%), soil moisture (VI=7.4%), elevation (VI=6.0%), and vegetation (VI=3.8%).

Conclusions:
Poverty and variables related to climate have become the crucial determinants of malaria in Indonesia. The government must strengthen malaria surveillance through climate change mitigation and adaptation programs and accelerate poverty alleviation programs to support malaria elimination.