Reactive Case Detection for Malaria Elimination: Real-Life Experience from an Ongoing Program in Swaziland
Reactive Case Detection for Malaria Elimination: Real-Life Experience from an Ongoing Program in Swaziland
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DOI：
10.1371/journal.pone.0063830
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发表时间：
2013-05-20
期刊：
影响因子：
3.7
通讯作者：
Gosling, Roly D.
中科院分区：
文献类型：
--
作者：
Sturrock, Hugh J. W.;Novotny, Joe M.;Gosling, Roly D.
随着各国朝着消灭疟疾的方向迈进，需要有办法查明不寻求治疗的人群中的感染情况。反应性病例检测是包括斯威士兰在内的一些国家正在采用的一种方法，即对居住在被动检测病例附近的个人进行筛查和治疗。一个突出的问题是围绕每个被动检测到的指示病例建立流行病学和操作上的最佳筛查半径。使用2009年12月至2012年6月从斯威士兰反应性病例检测（RACD）活动中收集的数据，我们评估了筛查半径和其他风险因素对反应性病例检测检测病例概率的影响。利用卫星图像，我们还评估了反应性病例检测期间实现的家庭覆盖率。在研究期间，250例病例触发了RACD，其中又确定了74例病例，显示了RACD相对于被动监测的价值。结果表明，在索引病例的家庭内检测到病例的几率显著高于邻近家庭（比值比（OR）13，95%CI 3.1-54.4）。此外，如果在卫生设施出现指数的一周内进行RACD（OR 8.7，95% CI 1.1-66.4），并且如果指数家庭没有喷洒杀虫剂（OR喷洒与未喷洒0.11，95% CI 0.03-0.46），则更有可能发现病例。RACD期间遗漏的大量家庭表明，在斯威士兰等资源有限的环境中，1公里的筛查半径可能不切实际。斯威士兰今后的区域艾滋病防治工作可以更加有效，办法是在靠近指示病例的个人和尚未进行喷洒的地区实现高覆盖率。除了使该方案能够更迅速地执行区域检查和控制方案外，这将有助于更准确地确定最佳检查半径。
As countries move towards malaria elimination, methods to identify infections among populations who do not seek treatment are required. Reactive case detection, whereby individuals living in close proximity to passively detected cases are screened and treated, is one approach being used by a number of countries including Swaziland. An outstanding issue is establishing the epidemiologically and operationally optimal screening radius around each passively detected index case. Using data collected between December 2009 and June 2012 from reactive case detection (RACD) activities in Swaziland, we evaluated the effect of screening radius and other risk factors on the probability of detecting cases by reactive case detection. Using satellite imagery, we also evaluated the household coverage achieved during reactive case detection. Over the study period, 250 cases triggered RACD, which identified a further 74 cases, showing the value of RACD over passive surveillance alone. Results suggest that the odds of detecting a case within the household of the index case were significantly higher than in neighbouring households (odds ratio (OR) 13, 95% CI 3.1-54.4). Furthermore, cases were more likely to be detected when RACD was conducted within a week of the index presenting at a health facility (OR 8.7, 95% CI 1.1-66.4) and if the index household had not been sprayed with insecticide (OR sprayed vs not sprayed 0.11, 95% CI 0.03-0.46). The large number of households missed during RACD indicates that a 1 km screening radius may be impractical in such resource limited settings such as Swaziland. Future RACD in Swaziland could be made more effective by achieving high coverage amongst individuals located near to index cases and in areas where spraying has not been conducted. As well as allowing the programme to implement RACD more rapidly, this would help to more precisely define the optimal screening radius.