Fig. 5

LISA cluster maps of human leishmaniasis incidence, Morocco, 2003–2013. The LISA indicated the presence or absence of significant spatial clusters or outliers for each province/prefecture. Significant clustering was seen from 2005 to 2013, during which the Errachidia province was considered to be a permanent ‘hot spot’ of human leishmaniasis (local Moran’s I highly significant P = 0.001). It seemed to be the main location from where leishmaniasis spread: from 2003 to 2007, high incidence clustering was observed in the north neighboring provinces (Figuig, Jrada, and Boulemane); in 2008, high incidence clustering disappeared from the north neighboring provinces and appeared in the south neighboring provinces (Ouarzazate and Zagora). From 2009, high incidence clusters again spread both north and south of the Errachidia province. Clusters disappeared in the north neighboring provinces in 2012 (showing a decrease in the Global Moran’s I statistic = 0.2993; P = 0.002), whereas they further spread, from 2010 to 2013, from the aforementioned south neighboring provinces all the way to southwestern neighboring provinces, such as Azilal and El Haouz. In 2013, a low incidence cluster surrounded by high incidence clusters was observed in the Errachidia province, explaining the further decrease in Global Moran’s I (Global Moran’s I statistic = 0.2491; P = 0.004). Clusters of low leishmaniasis incidence were observed in the southern part (Tan Tan, Tarfaya, Laayoun, Boujdour, and Essmara provinces), and in the northwestern part (Khemisset, Settat, Benslimane, Skhirat and Salé provinces, and Rabat prefecture) of the country