Descriptive GIS Analysis of Autism Spectrum Disorders in Kelantan, Malaysia: Severity Patterns and Service-Related Clusters

Abstract

Autism spectrum disorder (ASD) in Kelantan, Malaysia remains poorly characterized geographically, with stark diagnostic disparities by severity. Kelantan is predominantly rural, and no prior study has quantified the state's ASD spatial distribution. The present GIS-based analysis mapped 103 ASD diagnoses (13 severe, 30 high-functioning, 60 mild autism) by geocoding their locations. Mean centers of all cases lay near Kota Bharu, but dispersion differed markedly. Severe ASD cases formed a tight urban cluster (standard deviational ellipse area 250.52 m2) while mild autism cases were broadly dispersed (SDE 526.25 m2). LISA (Local Moran's I) revealed statistically significant high-high clusters of mild and high-functioning ASD in Kota Bharu and nearby districts, whereas severe ASD showed no contiguous hotspots. These patterns highlight urban-rural diagnostic disparities: milder ASD is over-represented in well-served cities, whereas severe ASD was relatively uniformly reported statewide. This first GIS-based spatial epidemiology of ASD in Kelantan provides novel insight into under-detection of mild autism cases in rural areas. These findings imply that screening and support services should be expanded beyond metropolitan areas to bridge Kelantan's urban-rural ASD care gap, guiding more equitable resource allocation. This spatial analysis offers a data-driven foundation for planning ASD surveillance, outreach, and interventions statewide, informing equitable policy.