Continued Decline of Malaria in The Gambia with Implications for Elimination
Continued Decline of Malaria in The Gambia with Implications for Elimination
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DOI：
10.1371/journal.pone.0012242
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发表时间：
2010-08-18
期刊：
影响因子：
3.7
通讯作者：
Conway, David J.
中科院分区：
文献类型：
--
作者：
Ceesay, Serign J.;Casals-Pascual, Climent;Conway, David J.
工作背景：据报告，在冈比亚西部，疟疾发病率在2007年之前的几年里大幅下降，这鼓励人们考虑今后在这一以前高度流行的地区消灭疟疾。自那以后，在全球基金和其他捐助者的支持下，干预措施的规模有所增加。方法/主要结果：我们继续检查先前研究的四个卫生设施的实验室记录，并调查了另外六个设施的7年期，增加了243，707张幻灯片检查的数据，以确定全国各地的趋势，直到2009年底。我们在整个2008年疟疾季节积极检测了800名农村儿童的社区队列感染，并在2006年至2009年期间分析了另一个农村人口的血清学变化。2003年（所有地点的年平均值为38.7%）至2009年（年平均值为7.9%）期间，所有10个卫生设施的疟疾阳性玻片比例显著下降。趋势的统计模型证实了每个设施的显著季节性和随时间的下降。2009年，所有地点的玻片阳性率最低，只有两个地点的玻片阳性率在2006年最低。对2007-2009年在后一个地点出现病例的家庭进行的绘图表明，这些病例并不局限于少数残余疫源地。2008年季节，农村儿童队列中只有2.8%（22/800）发生过疟疾，并且2006年至2009年间，另一个农村地区的血清学检测结果大幅下降。结论：冈比亚的疟疾持续下降，卫生机构的玻片阳性率呈下降趋势，社区调查中的发病率和血清阳性率也前所未有地低。我们建议在考虑消灭计划之前，加强几年的控制干预措施，以进一步降低发病率。
Background: A substantial decline in malaria was reported to have occurred over several years until 2007 in the western part of The Gambia, encouraging consideration of future elimination in this previously highly endemic region. Scale up of interventions has since increased with support from the Global Fund and other donors.Methodology/Principal Findings: We continued to examine laboratory records at four health facilities previously studied and investigated six additional facilities for a 7 year period, adding data from 243,707 slide examinations, to determine trends throughout the country until the end of 2009. We actively detected infections in a community cohort of 800 children living in rural villages throughout the 2008 malaria season, and assayed serological changes in another rural population between 2006 and 2009. Proportions of malaria positive slides declined significantly at all of the 10 health facilities between 2003 (annual mean across all sites, 38.7%) and 2009 (annual mean, 7.9%). Statistical modelling of trends confirmed significant seasonality and decline over time at each facility. Slide positivity was lowest in 2009 at all sites, except two where lowest levels were observed in 2006. Mapping households of cases presenting at the latter sites in 2007-2009 indicated that these were not restricted to a few residual foci. Only 2.8% (22/800) of a rural cohort of children had a malaria episode in the 2008 season, and there was substantial serological decline between 2006 and 2009 in a separate rural area.Conclusions: Malaria has continued to decline in The Gambia, as indicated by a downward trend in slide positivity at health facilities, and unprecedented low incidence and seroprevalence in community surveys. We recommend intensification of control interventions for several years to further reduce incidence, prior to considering an elimination programme.