Large-scale malaria survey in Cambodia: Novel insights on species distribution and risk factors
Large-scale malaria survey in Cambodia: Novel insights on species distribution and risk factors
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DOI：
10.1186/1475-2875-6-37
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发表时间：
2007-03-27
期刊：
影响因子：
3
通讯作者：
Fandeur, Thierry
中科院分区：
文献类型：
--
作者：
Incardona, Sandra;Vong, Sirenda;Fandeur, Thierry
背景资料：在柬埔寨，对疟疾负担的估计依赖于公共卫生信息系统，该系统没有记录偏远人口中发生的病例，也没有记录私营部门治疗的疟疾病例或无症状的携带者。因此，目前的疟疾形势和相关的风险因素的全球估计仍然lacking.Methods：一个大的横断面调查进行了三个领域的多药耐药疟疾在柬埔寨，招募11,652人。记录发热和脾肿大。疟疾流行率，寄生虫密度和感染的空间分布进行了测定，以确定寄生虫学的配置文件和相关的危险因素，有利于改善疟疾控制programmes in the national.Results：疟疾流行率为3.0%，7.0%和12.3%，在Sampovloun，戈公和柏威夏地区。流行率和疟原虫种类分布不均，在传播率低的地区间日疟原虫感染率较高。疟疾引起的发热仅占疟疾病例的10-33%，23-33%的寄生虫携带者发热。多变量多层次回归分析确定成人和男性，主要参与森林活动，作为高风险群体在Sampovloun，与其他地区的森林边缘村庄的儿童额外的风险，随着距离卫生设施的增加，风险沿着增加。结论：这些观察点一个更复杂的疟疾的情况比怀疑从官方报告。观察到一个大型无症状水库。间日疟原虫感染率高于几个地区的记录。在偏远地区，疟疾流行率很高。这表明，应在风险较高的地区，如该国偏远的农村和森林地区，建立更多的保健设施，这些地区的保健服务不足。需要在全国各地绘制精确的疟疾风险图，以评估疟疾流行和风险人群的广泛地理异质性，从而可以相应地加强目前的疟疾控制措施。
Background: In Cambodia, estimates of the malaria burden rely on a public health information system that does not record cases occurring among remote populations, neither malaria cases treated in the private sector nor asymptomatic carriers. A global estimate of the current malaria situation and associated risk factors is, therefore, still lacking.Methods: A large cross-sectional survey was carried out in three areas of multidrug resistant malaria in Cambodia, enrolling 11,652 individuals. Fever and splenomegaly were recorded. Malaria prevalence, parasite densities and spatial distribution of infection were determined to identify parasitological profiles and the associated risk factors useful for improving malaria control programmes in the country.Results: Malaria prevalence was 3.0%, 7.0% and 12.3% in Sampovloun, Koh Kong and Preah Vihear areas. Prevalences and Plasmodium species were heterogeneously distributed, with higher Plasmodium vivax rates in areas of low transmission. Malaria-attributable fevers accounted only for 10-33% of malaria cases, and 23-33% of parasite carriers were febrile. Multivariate multilevel regression analysis identified adults and males, mostly involved in forest activities, as high risk groups in Sampovloun, with additional risks for children in forest-fringe villages in the other areas along with an increased risk with distance from health facilities.Conclusion: These observations point to a more complex malaria situation than suspected from official reports. A large asymptomatic reservoir was observed. The rates of P. vivax infections were higher than recorded in several areas. In remote areas, malaria prevalence was high. This indicates that additional health facilities should be implemented in areas at higher risk, such as remote rural and forested parts of the country, which are not adequately served by health services. Precise malaria risk mapping all over the country is needed to assess the extensive geographical heterogeneity of malaria endemicity and risk populations, so that current malaria control measures can be reinforced accordingly.