Impact of Community-Based Larviciding on the Prevalence of Malaria Infection in Dar es Salaam, Tanzania
Impact of Community-Based Larviciding on the Prevalence of Malaria Infection in Dar es Salaam, Tanzania
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DOI：
10.1371/journal.pone.0071638
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发表时间：
2013-08-14
期刊：
影响因子：
3.7
通讯作者：
Castro, Marcia C.
中科院分区：
文献类型：
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作者：
Maheu-Giroux, Mathieu;Castro, Marcia C.
背景：尽管在历史上取得了成功，但撒哈拉以南非洲的当代疟疾控制计划并没有优先考虑使用幼虫来源管理。特别是在传播集中的城市地区，杀幼虫可能是有效的，而且通常比农村地区更容易进入按蚊繁殖地。本研究的目的是评估以社区为基础的微生物杀幼虫干预措施对降低坦桑尼亚联合共和国达累斯萨拉姆疟疾感染率的有效性。方法和结果：经过两年的基线数据收集，2006年在达累斯萨拉姆15个目标病房中的3个实施了杀幼虫。这一干预措施随后在一年后扩大到9个病房，并在2008年扩大到所有15个目标病房。在6轮调查期间(2004-2008年)对疟疾流行率和社会人口学特征进行了连续随机整群抽样，其中包括横断面和纵向数据(N=64,537)。采用贝叶斯随机效应Logistic回归模型，在个体水平上量化干预对疟疾流行的影响。效应大小估计表明，杀幼虫干预具有显著的保护作用。在调整混杂因素后，使用杀幼虫剂的地区居民感染疟疾的几率比未治疗地区的居民低21%(优势比=0.79；95%可信区间：0.66~0.93)。灭幼虫干预在旱季效果最好，并与其他防护措施如使用驱虫蚊帐和房屋防护网(即完全的天花板或窗帘)具有协同作用。结论：大规模社区灭幼虫干预显著降低了达累斯萨拉姆城市疟疾感染的患病率。
Background: The use of larval source management is not prioritized by contemporary malaria control programs in sub-Saharan Africa despite historical success. Larviciding, in particular, could be effective in urban areas where transmission is focal and accessibility to Anopheles breeding habitats is generally easier than in rural settings. The objective of this study is to assess the effectiveness of a community-based microbial larviciding intervention to reduce the prevalence of malaria infection in Dar es Salaam, United Republic of Tanzania.Methods and Findings: Larviciding was implemented in 3 out of 15 targeted wards of Dar es Salaam in 2006 after two years of baseline data collection. This intervention was subsequently scaled up to 9 wards a year later, and to all 15 targeted wards in 2008. Continuous randomized cluster sampling of malaria prevalence and socio-demographic characteristics was carried out during 6 survey rounds (2004-2008), which included both cross-sectional and longitudinal data (N = 64,537). Bayesian random effects logistic regression models were used to quantify the effect of the intervention on malaria prevalence at the individual level. Effect size estimates suggest a significant protective effect of the larviciding intervention. After adjustment for confounders, the odds of individuals living in areas treated with larviciding being infected with malaria were 21% lower (Odds Ratio = 0.79; 95% Credible Intervals: 0.66-0.93) than those who lived in areas not treated. The larviciding intervention was most effective during dry seasons and had synergistic effects with other protective measures such as use of insecticide-treated bed nets and house proofing (i.e., complete ceiling or window screens).Conclusion: A large-scale community-based larviciding intervention significantly reduced the prevalence of malaria infection in urban Dar es Salaam.