Quantifying the level of under-detection of Trypanosoma brucei rhodesiense sleeping sickness cases
Quantifying the level of under-detection of Trypanosoma brucei rhodesiense sleeping sickness cases
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DOI：
10.1111/j.1365-3156.2005.01470.x
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发表时间：
2005-09-01
影响因子：
3.3
通讯作者：
Woolhouse, MEJ
中科院分区：
文献类型：
--
作者：
Odiit, M;Coleman, PG;Woolhouse, MEJ
为了正式量化乌干达流行期间布氏锥虫昏睡病(SS)的漏检水平，开发了决策树(Under-Detect)模型；同时，为了量化寻求医疗保健但未诊断的未发现病例的子集，开发了确定性(子集)模型。根据1988年至1990年SS疫情期间在乌干达托罗罗市Liri医院就诊的760名SS患者出现症状前的症状持续时间和早期与晚期病例比率的先前公布的记录，估计出检测不足模型参数的值。对于观察到的早期与晚期比率0.47，我们估计LIRI医院集水区的漏检比例为0.39(95%可信区间0.37-0.41)，即39%的病例未报告。根据这个值，计算出每报告一例SS死亡，就有12.0例(95%可信区间11.0-13.0)的死亡没有在Liri医院的集水区被发现--即92%的死亡没有被报告。根据SS感染的可能途径构建的确定性(子集)模型显示，在总共73例未发现的死亡中，62例(CI 60-)(85%)进入医疗系统但没有得到诊断，11例(CI 11-12)在没有向公认的医疗单位寻求医疗保健的情况下死亡。早期到后期呈现的衡量标准提供了一种易于处理的衡量标准，以确定罗德希恩斯SS未被检测到的水平，并衡量旨在增加治疗覆盖率的干预措施的效果。
To formally quantify the level of under-detection of Trypanosoma brucei rhodesiense sleeping sickness (SS) during an epidemic in Uganda, a decision tree (under-detection) model was developed; concurrently, to quantify the subset of undetected cases that sought health care but were not diagnosed, a deterministic (subset) model was developed. The values of the under-detection model parameters were estimated from previously published records of the duration of symptoms prior to presentation and the ratio of early to late stage cases in 760 SS patients presenting at LIRI hospital, Tororo, Uganda during the 1988-1990 epidemic of SS. For the observed early to late stage ratio of 0.47, we estimate that the proportion of under-detection in the catchment area of LIRI hospital was 0.39 (95% CI 0.37-0.41) i.e. 39% of cases are not reported. Based on this value, it is calculated that for every one reported death of SS, 12.0 (95% CI 11.0-13.0) deaths went undetected in the LIRI hospital catchment area - i.e. 92% of deaths are not reported. The deterministic (subset) model structured on the possible routes of a SS infection to either diagnosis or death through the health system or out of it, showed that of a total of 73 undetected deaths, 62 (CI 60-64) (85%) entered the healthcare system but were not diagnosed, and 11 (CI 11-12) died without seeking health care from a recognized health unit. The measure of early to late stage presentation provides a tractable measure to determine the level of rhodesiense SS under-detection and to gauge the effects of interventions aimed at increasing treatment coverage.