Impact Evaluation of Malaria Control Interventions on Morbidity and All-Cause Child Mortality in Rwanda, 2000-2010
Impact Evaluation of Malaria Control Interventions on Morbidity and All-Cause Child Mortality in Rwanda, 2000-2010
复制标题
DOI：
10.4269/ajtmh.17-0281
复制
发表时间：
2017-01-01
影响因子：
3.3
通讯作者：
Karema, Corine
中科院分区：
文献类型：
--
作者：
Eckert, Erin;Florey, Lia S.;Karema, Corine
1996-2000年至2006-2010年期间，卢旺达儿童死亡率显著下降，与此同时，室内滞留喷洒、驱虫蚊帐的分发和使用以及疟疾病例管理得到改善等疟疾控制干预措施迅速增加。这些干预措施的影响进行了检查，通过生态相关性分析，和强大的分解分析的背景因素对全因儿童死亡率。在评估期间，儿童死亡率下降了61%，2005年至2010年期间，6-23个月儿童严重贫血的患病率下降了71%。疟疾发病率和死亡率的这些变化是在病媒控制活动大量增加的同时发生的。5岁以下儿童使用驱虫蚊帐的比例从4%上升到70%。美国国税局的计划始于2007年，到2010年覆盖了负担最重地区的130万人。与此同时，在全国范围内推广了有效的抗疟诊断和治疗，包括在社区一级向5岁以下儿童提供服务。5岁以下儿童因发烧寻求护理的比例从2000年的26%上升到2010年的48%。使用具有全国代表性的数据建立的2000年至2010年期间儿童死亡率变化的多变量模型显示，驱虫蚊帐拥有率的增加在解释所观察到的死亡率下降方面具有重要意义。总的来说，证据支持这样的结论，即疟疾控制干预措施有助于2000年至2010年期间观察到的卢旺达儿童死亡率下降，即使是在社会经济、孕产妇和儿童健康状况改善的背景下。
The impressive decline in child mortality that occurred in Rwanda from 1996-2000 to 2006-2010 coincided with a period of rapid increase of malaria control interventions such as indoor residual spraying (IRS); insecticide-treated net (ITN) distribution and use, and improved malaria case management. The impact of these interventions was examined through ecological correlation analysis, and robust decomposition analysis of contextual factors on all-cause child mortality. Child mortality fell 61% during the evaluation period and prevalence of severe anemia in children 6-23 months declined 71% between 2005 and 2010. These changes in malaria morbidity and mortality occurred concurrently with a substantial increase in vector control activities. ITN use increased among children under five, from 4% to 70%. The IRS program began in 2007 and covered 1.3 million people in the highest burden districts by 2010. At the same time, diagnosis and treatment with an effective antimalarial expanded nationally, and included making services available to children under the age of 5 at the community level. The percentage of children under 5 who sought care for a fever increased from 26% in 2000 to 48% in 2010. Multivariable models of the change in child mortality between 2000 and 2010 using nationally representative data reveal the importance of increasing ITN ownership in explaining the observed mortality declines. Taken as a whole, the evidence supports the conclusion that malaria control interventions contributed to the observed decline in child mortality in Rwanda from 2000 to 2010, even in a context of improving socioeconomic, maternal, and child health conditions.