Declines in Malaria Burden and All-Cause Child Mortality following Increases in Control Interventions in Senegal, 2005-2010
Declines in Malaria Burden and All-Cause Child Mortality following Increases in Control Interventions in Senegal, 2005-2010
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DOI：
10.4269/ajtmh.16-0953
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发表时间：
2017-01-01
影响因子：
3.3
通讯作者：
Ba, Mady
中科院分区：
文献类型：
--
作者：
Thwing, Julie;Eckert, Erin;Ba, Mady
疟疾在塞内加尔流行。国家疟疾控制战略的重点是实现主要干预措施的全民覆盖，目标是到2018年达到消灭前状态。塞内加尔于2006年开始分发驱虫蚊帐，并采用以青蒿素为基础的联合疗法，然后在2007年采用快速诊断检测。我们使用基于疟疾对五岁以下儿童全死因死亡率(ACCM)贡献的似是而非设计，并考虑可能影响ACCM的其他背景因素，评估了这些努力的影响。2005至2010年间，ITN的家庭拥有率从20%增加到63%，调查前一晚睡在ITN下的人比例从6%增加到29%。从2008年到2010年，5岁以下儿童的疟疾寄生虫流行率从6%下降到3%。儿童健康的一些非疟疾指标有所改善，如疫苗完全接种率从58%提高到%，但营养指标恶化，发育迟缓从16%增加到26%。虽然经济指标有所改善，但环境条件有利于疟疾传播的增加。2005至2010年间，AACM下降了40%，从每千人121人(95%可信区间[CI]113-129)降至72人(95%可信区间66-77)，疟疾风险最高的年龄组、流行病区和财富五分位数的下降幅度更大。在考虑了疟疾干预措施的覆盖面、疟疾发病率的趋势、背景因素的影响和非加索疟疾管理的趋势之后，疟疾控制干预措施有助于降低疟疾死亡率，并使塞内加尔的儿童存活率显著提高，这似乎是合理的。
Malaria is endemic in Senegal. The national malaria control strategy focuses on achieving universal coverage for major interventions, with a goal of reaching preelimination status by 2018. Senegal began distribution of insecticide-treated nets (ITNs) and introduced artemisinin-based combination therapy in 2006, then introduced rapid diagnostic tests in 2007. We evaluated the impact of these efforts using a plausibility design based on malaria's contribution to all-cause under-five mortality (ACCM) and considering other contextual factors which may influence ACCM. Between 2005 and 2010, household ownership of ITNs increased from 20% to 63%, and the proportion of people sleeping under an ITN the night prior to the survey increased from 6% to 29%. Malaria parasite prevalence declined from 6% to 3% from 2008 to 2010 among children under five. Some nonmalaria indicators of child health improved, for example, increase of complete vaccination coverage from 58% to 64%; however, nutritional indicators deteriorated, with an increase in stunting from 16% to 26%. Although economic indicators improved, environmental conditions favored an increase in malaria transmission. ACCM decreased 40% between 2005 and 2010, from 121 (95% confidence interval [CI] 113-129) to 72 (95% CI 66-77) per 1,000, and declines were greater among age groups, epidemiologic zones, and wealth quintiles most at risk for malaria. After considering coverage of malaria interventions, trends in malaria morbidity, effects of contextual factors, and trends in ACCM, it is plausible that malaria control interventions contributed to a reduction in malaria mortality and to the impressive gains in child survival in Senegal.