Indirect effects of the COVID-19 pandemic on malaria intervention coverage, morbidity, and mortality in Africa: a geospatial modelling analysis.
Indirect effects of the COVID-19 pandemic on malaria intervention coverage, morbidity, and mortality in Africa: a geospatial modelling analysis.
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DOI：
10.1016/s1473-3099(20)30700-3
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发表时间：
2021-01
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影响因子：
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通讯作者：
Gething PW
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作者：
Weiss DJ;Bertozzi-Villa A;Rumisha SF;Amratia P;Arambepola R;Battle KE;Cameron E;Chestnutt E;Gibson HS;Harris J;Keddie S;Millar JJ;Rozier J;Symons TL;Vargas-Ruiz C;Hay SI;Smith DL;Alonso PL;Noor AM;Bhatt S;Gething PW
自2000年以来，非洲在减轻疟疾负担方面取得了重大进展，但如果COVID-19大流行影响关键疟疾控制干预措施的可用性，这些成果可能会受到损害。本研究的目的是评估不同程度的疟疾控制中断对疟疾发病率和死亡率的可能影响。使用一组已建立的时空贝叶斯地统计模型，我们生成了疟疾流行的非洲国家的疟疾临床病例发病率和死亡率的地理空间估计，并将更新的寄生虫率调查数据库，驱虫蚊帐（ITN）覆盖率和有效治疗率。我们建立了在没有COVID-19相关干扰的情况下非洲预期疟疾负担的基线估计，并重复了对九种假设情景的分析，在这些情景中，抗疟药物的有效治疗和驱虫蚊帐的分发（通过常规渠道和群众运动）在不同程度上减少。我们估计，在不中断干预覆盖率的基线情景下，2020年非洲疟疾流行国家将有2.152亿（95%不确定性区间1.437 - 3.116）万例病例和3.864亿（3.078 - 497.8）万例死亡。随着获得有效抗疟药物治疗的机会进一步减少，我们的模型预测病例和死亡人数将增加：224·1（148.7 - 326.8）万例，487.9（385·3-634·6）千人死亡，抗疟药物覆盖率下降25%; 233·1（153.7 - 342.5）万例，597.4（468·0-784·4）千例死亡，减少50%; 242·3（158·7-358·8）万例病例和715·2（556·4-947·9）千例死亡，减少75%。停止计划中的2020年大规模驱虫蚊帐分发活动和将常规驱虫蚊帐分发减少25%-75%也使疟疾负担增加到230·5（151.6 - 343.3）万例，411.7（322.8 - 545.5）千例死亡，减少25%; 232.8（152.3 - 345.9）万例，415.5（324.3 - 549.4）万例死亡，减少50%; 234.0（152.9 - 348.4）万例病例和417.6（325.5 - 553.1）万例死亡，减少75%。当驱虫蚊帐覆盖率和抗疟药物覆盖率同步降低时，疟疾负担增加到240·5（156.5 - 358.2）万例，520.9（404.1 - 691.9）千例死亡，减少25%; 251.0（162.2 - 377.0）万例，640.2（492·0-856·7）千例死亡，减少50%; 261·6（167·7-396·8）万例病例和768·6（586·1-1038·7）千例死亡，减少75%。在悲观的情况下，与COVID-19相关的非洲疟疾控制中断可能会在2020年使疟疾死亡率几乎翻一番，并可能导致随后几年的更大增长。为了避免二十年来在防治疟疾方面取得的进展出现逆转，避免这场公共卫生灾难必须与应对COVID-19一起成为综合优先事项。比尔和梅林达盖茨基金会;第7频道Telethon信托，西澳大利亚州。
Substantial progress has been made in reducing the burden of malaria in Africa since 2000, but those gains could be jeopardised if the COVID-19 pandemic affects the availability of key malaria control interventions. The aim of this study was to evaluate plausible effects on malaria incidence and mortality under different levels of disruption to malaria control. Using an established set of spatiotemporal Bayesian geostatistical models, we generated geospatial estimates across malaria-endemic African countries of the clinical case incidence and mortality of malaria, incorporating an updated database of parasite rate surveys, insecticide-treated net (ITN) coverage, and effective treatment rates. We established a baseline estimate for the anticipated malaria burden in Africa in the absence of COVID-19-related disruptions, and repeated the analysis for nine hypothetical scenarios in which effective treatment with an antimalarial drug and distribution of ITNs (both through routine channels and mass campaigns) were reduced to varying extents. We estimated 215·2 (95% uncertainty interval 143·7–311·6) million cases and 386·4 (307·8–497·8) thousand deaths across malaria-endemic African countries in 2020 in our baseline scenario of undisrupted intervention coverage. With greater reductions in access to effective antimalarial drug treatment, our model predicted increasing numbers of cases and deaths: 224·1 (148·7–326·8) million cases and 487·9 (385·3–634·6) thousand deaths with a 25% reduction in antimalarial drug coverage; 233·1 (153·7–342·5) million cases and 597·4 (468·0–784·4) thousand deaths with a 50% reduction; and 242·3 (158·7–358·8) million cases and 715·2 (556·4–947·9) thousand deaths with a 75% reduction. Halting planned 2020 ITN mass distribution campaigns and reducing routine ITN distributions by 25%–75% also increased malaria burden to a total of 230·5 (151·6–343·3) million cases and 411·7 (322·8–545·5) thousand deaths with a 25% reduction; 232·8 (152·3–345·9) million cases and 415·5 (324·3–549·4) thousand deaths with a 50% reduction; and 234·0 (152·9–348·4) million cases and 417·6 (325·5–553·1) thousand deaths with a 75% reduction. When ITN coverage and antimalarial drug coverage were synchronously reduced, malaria burden increased to 240·5 (156·5–358·2) million cases and 520·9 (404·1–691·9) thousand deaths with a 25% reduction; 251·0 (162·2–377·0) million cases and 640·2 (492·0–856·7) thousand deaths with a 50% reduction; and 261·6 (167·7–396·8) million cases and 768·6 (586·1–1038·7) thousand deaths with a 75% reduction. Under pessimistic scenarios, COVID-19-related disruption to malaria control in Africa could almost double malaria mortality in 2020, and potentially lead to even greater increases in subsequent years. To avoid a reversal of two decades of progress against malaria, averting this public health disaster must remain an integrated priority alongside the response to COVID-19. Bill and Melinda Gates Foundation; Channel 7 Telethon Trust, Western Australia.