Effectiveness of malaria control interventions in Madagascar: a nationwide case-control survey
Effectiveness of malaria control interventions in Madagascar: a nationwide case-control survey
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DOI：
10.1186/s12936-016-1132-x
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发表时间：
2016-02-11
期刊：
影响因子：
3
通讯作者：
Rogier, Christophe
中科院分区：
文献类型：
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作者：
Kesteman, Thomas;Randrianarivelojosia, Milijaona;Rogier, Christophe
背景资料：马达加斯加与其他疟疾流行国家一样，主要依赖国际资金来实施疟疾控制干预措施（MCI）。由于这些基金不再增加，政策制定者需要知道这些MCI是否真的提供了预期的保护。本研究旨在衡量2012-2013年在马达加斯加所有传播模式中部署的MCI对临床疟疾病例发生的有效性。2012年9月至2013年8月，在31个哨点卫生中心咨询非并发症疟疾的患者被要求回答一份关于长效驱虫蚊帐使用情况的简短问卷，家庭室内滞留喷洒和孕妇间歇性预防治疗。对照组是从SHC周围地区进行的同期横断面调查中抽取的健康的所有年龄段的个体。如果病例和对照是同一社区的居民，则将其保留在数据库中。疟原虫感染和暴露于MCI之间的关联计算的多变量多水平模型，和干预措施的保护效果（PE）被定义为1减去此association.Results的比值比：数据约841例（6760例观察SHC）和8284对照。在多变量分析中，定期使用LLIN提供了显著的51% PE（95% CI [16-71]），排除了一种传播模式，其中在单变量分析中PE为-11%（95% CI [-251至65]）。在多变量分析中，IRS的PE为51%（95% CI [31-65]），暴露于LLIN和IRS的PE为72%（95% CI [28-89]）。在马达加斯加，病媒控制干预措施每年避免了10万多例疟疾临床病例。结论：在马达加斯加，LLIN和IRS对临床疟疾有良好的PE。这些结果可能适用于具有类似传播特征的其他国家，但可以建议进行这种病例对照调查，以确定MCI有效性的地方失败。
Background: Madagascar, as other malaria endemic countries, depends mainly on international funding for the implementation of malaria control interventions (MCI). As these funds no longer increase, policy makers need to know whether these MCI actually provide the expected protection. This study aimed at measuring the effectiveness of MCI deployed in all transmission patterns of Madagascar in 2012-2013 against the occurrence of clinical malaria cases.Methods: From September 2012 to August 2013, patients consulting for non-complicated malaria in 31 sentinel health centres (SHC) were asked to answer a short questionnaire about long-lasting insecticidal nets (LLIN) use, indoor residual spraying (IRS) in the household and intermittent preventive treatment of pregnant women (IPTp) intake. Controls were healthy all-ages individuals sampled from a concurrent cross-sectional survey conducted in areas surrounding the SHC. Cases and controls were retained in the database if they were resident of the same communes. The association between Plasmodium infection and exposure to MCI was calculated by multivariate multilevel models, and the protective effectiveness (PE) of an intervention was defined as 1 minus the odds ratio of this association.Results: Data about 841 cases (out of 6760 cases observed in SHC) and 8284 controls was collected. The regular use of LLIN provided a significant 51 % PE (95 % CI [16-71]) in multivariate analysis, excluding in one transmission pattern where PE was - 11 % (95 % CI [-251 to 65]) in univariate analysis. The PE of IRS was 51 % (95 % CI [31-65]), and the PE of exposure to both regular use of LLIN and IRS was 72 % (95 % CI [28-89]) in multivariate analyses. Vector control interventions avoided yearly over 100,000 clinical cases of malaria in Madagascar. The maternal PE of IPTp was 73 %.Conclusions: In Madagascar, LLIN and IRS had good PE against clinical malaria. These results may apply to other countries with similar transmission profiles, but such case-control surveys could be recommended to identify local failures in the effectiveness of MCI.