Prevention of malaria in Afghanistan through social marketing of insecticide-treated nets: evaluation of coverage and effectiveness by cross-sectional surveys and passive surveillance
Prevention of malaria in Afghanistan through social marketing of insecticide-treated nets: evaluation of coverage and effectiveness by cross-sectional surveys and passive surveillance
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DOI：
10.1046/j.1365-3156.2002.00940.x
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发表时间：
2002-10-01
影响因子：
3.3
通讯作者：
Mohammed, N
中科院分区：
文献类型：
--
作者：
Rowland, M;Webster, J;Mohammed, N
在经历战争或冲突的国家，由于卫生系统崩溃、弱势人口流离失所以及流行病风险增加，疟疾往往是一个重大的健康问题。经过23年的冲突，疟疾在阿富汗许多农村地区流行。从1993年至今，一个由国际保健网协调的非政府组织网络在低地地区开展了蚊帐销售和再处理方案。为了检查基于驱虫蚊帐（ITN）的战略是否是应对疟疾的可行公共卫生解决方案，社区有机会购买蚊帐，然后进行监测以确定人口覆盖范围和疾病控制影响。这是使用两种对比的方法进行的：横断面调查和被动监测，从诊所使用病例对照设计。59%的家庭购买了蚊帐。横断面调查表明，与非使用者相比，ITN使用者的恶性疟原虫感染风险降低了59%（OR 0.41; 95%CI 0.25 - 0.66）。被动监测方法显示，在驱虫蚊帐使用者中，症状性恶性疟原虫疟疾的风险降低程度相当（OR 0.31; 95%CI 0.21 - 0.47）。横断面方法显示，与非使用者相比，ITN使用者的间日疟原虫感染风险降低50%（OR 0.50; 95%CI 0.17 - 1.49），但这种影响没有统计学意义。被动监测方法显示症状性间日疟原虫疟疾风险降低25%（OR 0.75; 95%CI 0.66 - 0.85）。ITN似乎对间日疟原虫的效果较低，因为复发性感染;因此，效果需要一个以上的季节才能显现出来。被动监测的成本较低，并给出了与横断面调查一致的结果。未经处理的蚊帐提供了一些保护。没有收集关于社会经济地位的数据，这是一个潜在的混杂因素。然而，在净销售时，购买者和非购买者之间的疟疾流行率没有差别。主要媒介斯氏按蚊的丰度似乎不受ITN的影响。驱虫蚊帐是在长期紧急情况下防止疟疾的为数不多的可行选择之一。
Malaria is often a major health problem in countries undergoing war or conflict owing to breakdown of health systems, displacement of vulnerable populations, and the increased risk of epidemics. After 23 years of conflict, malaria has become prevalent in many rural areas of Afghanistan. From 1993 to the present, a network of non-governmental organizations, co-ordinated by HealthNet International, has operated a programme of bednet sales and re-treatment in lowland areas. To examine whether a strategy based on insecticide-treated nets (ITN) is a viable public health solution to malaria, communities were given the opportunity to buy nets and then monitored to determine population coverage and disease control impact. This was carried out using two contrasting methods: cross-sectional surveys and passive surveillance from clinics using a case-control design. Nets were purchased by 59% of families. Cross-sectional surveys demonstrated a 59% reduction in the risk of Plasmodium falciparum infection among ITN users compared with non-users (OR 0.41; 95% CI 0.25-0.66). The passive surveillance method showed a comparable reduction in the risk of symptomatic P. falciparum malaria among ITN users (OR 0.31; 95% CI 0.21-0.47). The cross-sectional method showed a 50% reduction in risk of P. vivax infection in ITN users compared with non-users (OR 0.50; 95% CI 0.17-1.49) but this effect was not statistically significant. The passive surveillance method showed a 25% reduction in the risk of symptomatic P. vivax malaria (OR 0.75; 95% CI 0.66-0.85). ITN appeared to be less effective against P. vivax because of relapsing infections; hence an effect took more than one season to become apparent. Passive surveillance was cheaper to perform and gave results consistent with cross-sectional surveys. Untreated nets provided some protection. Data on socioeconomic status, a potential confounding factor, was not collected. However, at the time of net sales, there was no difference in malaria prevalence between buyers and non-buyers. The abundance of Anopheles stephensi , the main vector, did not appear to be affected by ITN. ITN constitute one of the few feasible options for protection against malaria in chronic emergencies.