Households or Hotspots? Defining Intervention Targets for Malaria Elimination in Ratanakiri Province, Eastern Cambodia
Households or Hotspots? Defining Intervention Targets for Malaria Elimination in Ratanakiri Province, Eastern Cambodia
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DOI：
10.1093/infdis/jiz211
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发表时间：
2019-09-15
影响因子：
6.4
通讯作者：
Van Bortel, Wim
中科院分区：
文献类型：
--
作者：
Bannister-Tyrrell, Melanie;Krit, Meryam;Van Bortel, Wim
背景疟疾“热点”已被提议作为有针对性地消灭疟疾的潜在干预单位。关于撒哈拉以南非洲以外地区的热点形成和稳定性知之甚少。在柬埔寨东部的3个村庄，在家庭和热点一级的疟原虫感染的聚集性进行了为期2年的评估。计算社会和空间自相关统计量以评估疟疾风险的聚集性，并使用逻辑回归评估第一年生活在疟疾热点与生活在疟疾阳性家庭对第二年疟疾感染风险的影响。2016年和2017年，疟原虫感染的粗患病率分别为8.4%和3.6%。2016年生活在热点地区并不能预测2017年整体个人或家庭层面的疟原虫风险，但2016年生活在疟原虫阳性家庭中强烈预测2017年生活在疟原虫阳性家庭中（风险比，5.00 [95%置信区间，2.09-11.96]，P < .0001）。没有一致的证据表明疟疾风险聚集在来自不同家庭的社会关系个体群体中。2年来，疟疾风险在家庭中的聚集比在热点地区更为明显。在该地区消除疟疾方案中，应以家庭为基础的战略为优先事项。
Background. Malaria "hotspots" have been proposed as potential intervention units for targeted malaria elimination. Little is known about hotspot formation and stability in settings outside sub-Saharan Africa.Methods. Clustering of Plasmodium infections at the household and hotspot level was assessed over 2 years in 3 villages in eastern Cambodia. Social and spatial autocorrelation statistics were calculated to assess clustering of malaria risk, and logistic regression was used to assess the effect of living in a malaria hotspot compared to living in a malaria-positive household in the first year of the study on risk of malaria infection in the second year.Results. The crude prevalence of Plasmodium infection was 8.4% in 2016 and 3.6% in 2017. Living in a hotspot in 2016 did not predict Plasmodium risk at the individual or household level in 2017 overall, but living in a Plasmodium-positive household in 2016 strongly predicted living in a Plasmodium-positive household in 2017 (Risk Ratio, 5.00 [95% confidence interval, 2.09-11.96], P < .0001). There was no consistent evidence that malaria risk clustered in groups of socially connected individuals from different households.Conclusions. Malaria risk clustered more clearly in households than in hotspots over 2 years. Household-based strategies should be prioritized in malaria elimination programs in this region.