Viewpoint:: Evaluating the impact of malaria control efforts on mortality in sub-Saharan Africa
Viewpoint:: Evaluating the impact of malaria control efforts on mortality in sub-Saharan Africa
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DOI：
10.1111/j.1365-3156.2007.01961.x
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发表时间：
2007-12-01
影响因子：
3.3
通讯作者：
Reithinger, Richard
中科院分区：
文献类型：
--
作者：
Vega, Juan Carlos;Sanchez, Boris Fernando;Reithinger, Richard
目的描述一种方法来评估疟疾控制工作对撒哈拉以南非洲疟疾相关死亡率的影响，在那里疾病特异性死亡率趋势通常不能直接测量，大多数疟疾死亡发生在幼儿中。方法评估疟疾相关死亡率变化的方法进行了检查;优点和缺点。结果所有方法都需要一个可行性论证-即，假设如果在扩大干预措施和死亡率趋势之间的因果关系路径的步骤中发现改进，则死亡率的降低可归因于方案努力。由于不同的方法提供了互补的信息，因此可以一起使用。我们建议跟踪疟疾控制干预措施覆盖面的趋势、影响儿童死亡率的其他因素、与疟疾有关的发病率（特别是贫血）和全因儿童死亡率。这一方法反映了疟疾直接和间接死亡率负担的减少，几乎所有国家都可以对其进行审查。增加其他信息可以加强可信性论点：疟疾传播指标的趋势、来自人口监测系统和系统使用疟疾诊断的哨点的信息，以及与代表性住户调查有关的口头尸检。保健设施关于疟疾死亡的数据有众所周知的局限性;但是，在特定情况下，这些数据可以提供可靠的趋势。基于模型的预测，可以帮助描述疟疾的具体负担的变化，并协助与程序管理和advocations.CONCLUSIONS尽管面临挑战，努力减少疟疾相关的死亡率在非洲可以评估疟疾干预覆盖率和全因儿童死亡率的趋势。在有资源和兴趣的情况下，可以增加关于疟疾发病率和疟疾死亡率的补充数据。
OBJECTIVE To describe an approach for evaluating the impact of malaria control efforts on malaria-associated mortality in sub-Saharan Africa, where disease-specific mortality trends usually cannot be measured directly and most malaria deaths occur among young children.METHODS Methods for evaluating changes in malaria-associated mortality are examined; advantages and disadvantages are presented.RESULTS All methods require a plausibility argument - i.e., an assumption that mortality reductions can be attributed to programmatic efforts if improvements are found in steps of the causal pathway between intervention scale-up and mortality trends. As different methods provide complementary information, they can be used together. We recommend following trends in the coverage of malaria control interventions, other factors influencing childhood mortality, malaria-associated morbidity (especially anaemia), and all-cause childhood mortality. This approach reflects decreases in malaria's direct and indirect mortality burden and can be examined in nearly all countries. Adding other information can strengthen the plausibility argument: trends in indicators of malaria transmission, information from demographic surveillance systems and sentinel sites where malaria diagnostics are systematically used, and verbal autopsies linked to representative household surveys. Health facility data on malaria deaths have well-recognized limitations; however, in specific circumstances, they could produce reliable trends. Model-based predictions can help describe changes in malaria-specific burden and assist with program management and advocacy.CONCLUSIONS Despite challenges, efforts to reduce malaria-associated mortality in Africa can be evaluated with trends in malaria intervention coverage and all-cause childhood mortality. Where there are resources and interest, complementary data on malaria morbidity and malaria-specific mortality could be added.