Malaria Burden through Routine Reporting: Relationship between Incidence and Test Positivity Rates
Malaria Burden through Routine Reporting: Relationship between Incidence and Test Positivity Rates
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DOI：
10.4269/ajtmh.18-0901
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发表时间：
2019-01-01
影响因子：
3.3
通讯作者：
Pullan, Rachel L.
中科院分区：
文献类型：
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作者：
Kigozi, Simon P.;Kigozi, Ruth N.;Pullan, Rachel L.
检测阳性率-每100个检测的疑似病例中的确诊病例和检测确诊疟疾病例率-每1 000人中的病例，是疟疾监测常规使用的共同指标。然而，很少有研究探讨这些指标在时间和空间上的关系。我们研究了2011年10月至2016年6月在乌干达Nagongera、Kihihi和Walukuba的四级卫生中心门诊部就诊的11岁以下疑似疟疾儿童中这些指标之间的关系。我们评估了指标在时间和空间上的趋势，并使用多变量回归模型探索了相关性。总共有65 710名参与者访问了这三个诊所。TPR和IR按月份进行的成对比较显示出相似的趋势，特别是TPR < 50%和低传播季节，但按村庄进行的关系复杂。村平均每年的TPR保持不变，而IR急剧下降，距离卫生中心。离医疗中心最远的村庄（距离的第四个四分位数）的IR显著低于附近的村庄（第一四分位数），Nagongera的发病率比率为0.40（95% CI：0.23-0.63; P = 0.001），Kihihi为0.55（0.40-0.75; P < 0.001），Walukuba为0.25（0.12-0.51; P < 0.001）。回归分析结果强调TPR和IR之间的非线性（立方）关系，占月，村，季节和人口因素。结果表明，这两个指标与监测疟疾负担高度相关。然而，解释不同，TPR主要表明疟疾治疗资源的需求和IR表明卫生设施集水区人口中的疟疾风险。
Test positivity rate (TPR)-confirmed cases per 100 suspected cases tested, and test-confirmed malaria case rate (IR)-cases per 1,000 population, are common indicators used routinely for malaria surveillance. However, few studies have explored relationships between these indicators over time and space. We studied the relationship between these indicators in children aged < 11 years presenting with suspected malaria to the outpatient departments of level IV health centers in Nagongera, Kihihi, and Walukuba in Uganda from October 2011 to June 2016. We evaluated trends in indicators over time and space, and explored associations using multivariable regression models. Overall, 65,710 participants visited the three clinics. Pairwise comparisons of TPR and IR by month showed similar trends, particularly for TPRs < 50% and during low-transmission seasons, but by village, the relationship was complex. Village mean annual TPRs remained constant, whereas IRs drastically declined with increasing distance from the health center. Villages that were furthest away from the health centers (fourth quartile for distance) had significantly lower IRs than nearby villages (first quartile), with an incidence rate ratio of 0.40 in Nagongera (95% CI: 0.23-0.63; P = 0.001), 0.55 in Kihihi (0.40-0.75; P < 0.001), and 0.25 in Walukuba (0.12-0.51; P < 0.001). Regression analysis results emphasized a nonlinear (cubic) relationship between TPR and IR, after accounting for month, village, season, and demographic factors. Results show that the two indicators are highly relevant for monitoring malaria burden. However, interpretation differs with TPR primarily indicating demand for malaria treatment resources and IR indicating malaria risk among health facility catchment populations.