The impact of sustained malaria control in the Loreto region of Peru: a retrospective, observational, spatially-varying interrupted time series analysis of the PAMAFRO program.
The impact of sustained malaria control in the Loreto region of Peru: a retrospective, observational, spatially-varying interrupted time series analysis of the PAMAFRO program.
复制标题
DOI：
10.1016/j.lana.2023.100477
复制
发表时间：
2023-04
期刊：
影响因子：
--
通讯作者：
Pan, William K.
中科院分区：
文献类型：
--
作者：
Janko, Mark M.;Recalde-Coronel, G. Cristina;Damasceno, Camila P.;Salmon-Mulanovich, Gabriela;Barbieri, Alisson F.;Lescano, Andres G.;Zaitchik, Benjamin F.;Pan, William K.
尽管自2000年以来，全世界的疟疾防治投资已使传播率大幅下降，但进展停滞不前。在亚马逊地区，疟疾在全球基金撤销对安第斯边境地区疟疾控制项目的支助后死灰复燃。我们估计干预的具体和空间明确的影响PAMAFRO计划疟疾发病率在整个洛雷托地区的秘鲁，并考虑存在的干预措施的环境风险因素的影响。我们对2001年1月第一个流行病学周至2016年12月最后一个流行病学周期间，秘鲁洛雷托卫生站报告人群的疟疾发病率进行了回顾性、观察性、空间中断时间序列分析。模型推断是在最小的行政单位（区），其中通过显微镜检查确定了间日疟原虫和恶性疟原虫的每周诊断病例数。人口普查数据提供了面临风险的人口。我们包括作为协变量每周估计的最低温度和累积降水量在每个地区，以及空间和时间滞后的疟疾发病率。环境数据来自为亚马逊河设计的水文气象模型。我们使用贝叶斯时空建模技术来估计PAMAFRO计划的影响，环境影响的变化，以及PAMAFRO退出后气候异常对传输的作用。在PAMAFRO项目期间，间日疟原虫的发病率从42.8例/1000人/年下降到10.1例/1000人/年。同期恶性疟原虫的发病率从14.3例/1000人/年下降到2.5例/1000人/年。PAMAFRO支持的干预措施的效果因地理和疟疾种类而异。干预措施只有在周边地区也部署了干预措施的地区才有效。此外，干预措施减少了其他普遍存在的人口和环境风险因素的影响。该计划的撤销导致了传播的复苏。从2011年起，最低气温的上升、降雨的多变性和强度，以及随之而来的人口流离失所，都促成了这一现象的再次出现。疟疾控制计划必须考虑干预措施的气候和环境范围，以最大限度地发挥效力。它们还必须确保财政上的可持续性，以维持地方在预防和消除疟疾工作方面取得的进展和作出的承诺，并抵消环境变化增加传播风险的影响。, , .
Although malaria control investments worldwide have resulted in dramatic declines in transmission since 2000, progress has stalled. In the Amazon, malaria resurgence has followed withdrawal of Global Fund support of the Project for Malaria Control in Andean Border Areas (PAMAFRO). We estimate intervention-specific and spatially-explicit effects of the PAMAFRO program on malaria incidence across the Loreto region of Peru, and consider the influence of the environmental risk factors in the presence of interventions. We conducted a retrospective, observational, spatial interrupted time series analysis of malaria incidence rates among people reporting to health posts across Loreto, Peru between the first epidemiological week of January 2001 and the last epidemiological week of December 2016. Model inference is at the smallest administrative unit (district), where the weekly number of diagnosed cases of Plasmodium vivax and Plasmodium falciparum were determined by microscopy. Census data provided population at risk. We include as covariates weekly estimates of minimum temperature and cumulative precipitation in each district, as well as spatially- and temporally-lagged malaria incidence rates. Environmental data were derived from a hydrometeorological model designed for the Amazon. We used Bayesian spatiotemporal modeling techniques to estimate the impact of the PAMAFRO program, variability in environmental effects, and the role of climate anomalies on transmission after PAMAFRO withdrawal. During the PAMAFRO program, incidence of P. vivax declined from 42.8 to 10.1 cases/1000 people/year. Incidence for P. falciparum declined from 14.3 to 2.5 cases/1000 people/year over this same period. The effects of PAMAFRO-supported interventions varied both by geography and species of malaria. Interventions were only effective in districts where interventions were also deployed in surrounding districts. Further, interventions diminished the effects of other prevailing demographic and environmental risk factors. Withdrawal of the program led to a resurgence in transmission. Increasing minimum temperatures and variability and intensity of rainfall events from 2011 onward and accompanying population displacements contributed to this resurgence. Malaria control programs must consider the climate and environmental scope of interventions to maximize effectiveness. They must also ensure financial sustainability to maintain local progress and commitment to malaria prevention and elimination efforts, as well as to offset the effects of environmental change that increase transmission risk. , , .
登录
查看更多内容
影响因子：
3.7
作者：
Beck-Johnson LM;Nelson WA;Paaijmans KP;Read AF;Thomas MB;Bjørnstad ON
通讯作者：
Bjørnstad ON
影响因子：
3.7
作者：
Gnanguenon V;Azondekon R;Oke-Agbo F;Beach R;Akogbeto M
通讯作者：
Akogbeto M
影响因子：
3.9
作者：
Barbieri, AF;Carr, DL
通讯作者：
Carr, DL
影响因子：
3.8
作者：
Manrique, Paulo;Miranda-Alban, Julio;Gamboa, Dionicia
通讯作者：
Gamboa, Dionicia
影响因子：
3
作者：
Moreno, Marta;Saavedra, Marlon P.;Conn, Jan E.
通讯作者：
Conn, Jan E.