Mapping the burden of cholera in sub-Saharan Africa and implications for control: an analysis of data across geographical scales.
Mapping the burden of cholera in sub-Saharan Africa and implications for control: an analysis of data across geographical scales.
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DOI：
10.1016/s0140-6736(17)33050-7
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发表时间：
2018-05-12
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影响因子：
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通讯作者：
Azman AS
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文献类型：
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作者：
Lessler J;Moore SM;Luquero FJ;McKay HS;Grais R;Henkens M;Mengel M;Dunoyer J;M'bangombe M;Lee EC;Djingarey MH;Sudre B;Bompangue D;Fraser RSM;Abubakar A;Perea W;Legros D;Azman AS
霍乱仍然是撒哈拉以南非洲和全世界持续存在的健康问题。霍乱可以通过适当的水和卫生设施控制，或通过口服霍乱疫苗，提供短暂的（103年）保护，尽管疫苗供应仍然稀缺。我们的目标是绘制撒哈拉以南非洲的霍乱负担图，并评估地理定位如何能够导致更有效的干预措施。我们综合了2010年至2016年撒哈拉以南非洲（不包括吉布提和厄立特里亚）霍乱发病率的信息，这些信息来自世卫组织、无国界医生组织、ProMED、救济网、卫生部和科学文献的数据集。我们将研究区域划分为20 km × 20 km的网格单元，并对每个网格单元中的年度霍乱发病率进行建模，假设泊松过程针对协变量和空间相关随机效应进行了调整。 我们将这些发现与人口分布数据相结合，以估计生活在霍乱高发地区（每年每1000人中有1例）的人数。我们还估计了通过在霍乱高发地区采取霍乱预防和控制干预措施可以减少霍乱发病率。我们在分析中包括了279个数据集，覆盖了2283个地点。在撒哈拉以南非洲（不包括吉布提和厄立特里亚），平均每年报告141918例霍乱病例（95%可信区间[CrI] 141 538-146 505）。 4.0%（95%CrI 1.7 - 16.8）的地区，有8720万人（95%CrI 6030万至1.189亿），霍乱发病率高。通过首先关注发病率最高的地区，有效的有针对性的干预措施可以消除该地区50%的霍乱，覆盖3530万人（95% CrI 2630万至6200万），不到总人口的4%。虽然霍乱发生在整个撒哈拉以南非洲，但其最高发病率集中在非洲大陆的一小部分地区。优先考虑高风险地区可以大大提高霍乱控制方案的效率。比尔和梅琳达·盖茨基金会
Cholera remains a persistent health problem in sub-Saharan Africa and worldwide. Cholera can be controlled through appropriate water and sanitation, or by oral cholera vaccination, which provides transient (∼3 years) protection, although vaccine supplies remain scarce. We aimed to map cholera burden in sub-Saharan Africa and assess how geographical targeting could lead to more efficient interventions. We combined information on cholera incidence in sub-Saharan Africa (excluding Djibouti and Eritrea) from 2010 to 2016 from datasets from WHO, Médecins Sans Frontières, ProMED, ReliefWeb, ministries of health, and the scientific literature. We divided the study region into 20 km × 20 km grid cells and modelled annual cholera incidence in each grid cell assuming a Poisson process adjusted for covariates and spatially correlated random effects. We combined these findings with data on population distribution to estimate the number of people living in areas of high cholera incidence (>1 case per 1000 people per year). We further estimated the reduction in cholera incidence that could be achieved by targeting cholera prevention and control interventions at areas of high cholera incidence. We included 279 datasets covering 2283 locations in our analyses. In sub-Saharan Africa (excluding Djibouti and Eritrea), a mean of 141 918 cholera cases (95% credible interval [CrI] 141 538–146 505) were reported per year. 4·0% (95% CrI 1·7–16·8) of districts, home to 87·2 million people (95% CrI 60·3 million to 118·9 million), have high cholera incidence. By focusing on the highest incidence districts first, effective targeted interventions could eliminate 50% of the region's cholera by covering 35·3 million people (95% CrI 26·3 million to 62·0 million), which is less than 4% of the total population. Although cholera occurs throughout sub-Saharan Africa, its highest incidence is concentrated in a small proportion of the continent. Prioritising high-risk areas could substantially increase the efficiency of cholera control programmes. The Bill & Melinda Gates Foundation.