Supporting data.

Background
Human plague cases are reported annually in the central highland regions of Madagascar, where the disease is endemic. The socioenvironmental characteristics and lifestyles of the populations of the central highland localities could be linked to this endemicity. The aim of this study was to determine socioenvironmental determinants that may be associated with plague risk and explain this variation in epidemiological contexts.
Methods
The current study was based on the distribution of plague cases between 2006 and 2015 that occurred in localities of districts positioned in the central highlands. Household surveys were performed from June to August 2017 using a questionnaire and direct observations on the socioenvironmental aspects of households in selected localities. Bivariate and multivariate analyses were performed to highlight the socioenvironmental parameters associated with plague risk in both districts.
Results
A total of 503 households were surveyed, of which 54.9% (276/503) were in Ambositra and 45.1% (227/503) were in Tsiroanomandidy. Multivariate analyses showed that thatched roofs [adjusted odds ratio (AOR): 2.63; 95% confidence interval (95% CI): 1.78–3.88] and ground floor houses [AOR: 2.11; 95% CI: 1.3–3.45-] were significantly associated with the vulnerability of a household to plague risk (p value<0.05).
Conclusions
Plague risk in two districts of the Malagasy central highlands is associated with human socioenvironmental characteristics. Socioenvironmental characteristics are parameters expressing spatial heterogeneity through the difference in epidemiological expression of the plague in Ambositra and Tsiroanomandidy. These characteristics could be used as indicators of vulnerability to plague risk in plague-endemic areas.

研究背景
马达加斯加中部高原地区每年均有人类鼠疫病例报告，该区域为鼠疫地方性流行区。当地居民的社会环境特征与生活方式，或与该地区的鼠疫地方性流行特征存在关联。本研究旨在明确与鼠疫感染风险相关的社会环境决定因素，以阐释该区域在流行病学层面的鼠疫流行差异。

研究方法
本研究以2006-2015年马达加斯加中部高原各区县报告的鼠疫病例分布数据为研究基础。2017年6月至8月，研究团队针对选定区域的住户，通过问卷调查与实地观察的方式，收集其社会环境相关信息。通过双变量与多变量统计分析，明确两个区县内与鼠疫感染风险相关的社会环境参数。

研究结果
本研究共完成503户住户的调查，其中54.9%（276/503）的受访住户来自安博西特拉（Ambositra），45.1%（227/503）来自齐鲁阿诺曼迪迪（Tsiroanomandidy）。多变量统计分析结果显示，茅草屋顶[校正比值比（adjusted odds ratio, AOR）：2.63；95%置信区间（95% confidence interval, 95% CI）：1.78~3.88]与底层住宅与住户鼠疫感染风险易感性显著相关（p<0.05）。

研究结论
马达加斯加中部高原两个区县的鼠疫感染风险，与居民的社会环境特征显著相关。社会环境特征可通过安博西特拉与齐鲁阿诺曼迪迪两地鼠疫流行病学表现的差异，体现鼠疫流行的空间异质性。此类社会环境特征可作为鼠疫流行区住户鼠疫感染风险易感性的评估指标。