Population coverage of artemisinin-based combination treatment in children younger than 5 years with fever and Plasmodium falciparum infection in Africa, 2003-2015: a modelling study using data from national surveys.
Population coverage of artemisinin-based combination treatment in children younger than 5 years with fever and Plasmodium falciparum infection in Africa, 2003-2015: a modelling study using data from national surveys.
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DOI：
10.1016/s2214-109x(17)30076-1
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发表时间：
2017-04
期刊：
影响因子：
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通讯作者：
Eisele TP
中科院分区：
文献类型：
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作者：
Bennett A;Bisanzio D;Yukich JO;Mappin B;Fergus CA;Lynch M;Cibulskis RE;Bhatt S;Weiss DJ;Cameron E;Gething PW;Eisele TP
以青蒿素为基础的联合疗法(ACTs)是治疗无并发症恶性疟原虫感染的最有效方法。监测和评估疟疾治疗复盖面进展情况的一个常用指标是过去14天内报告发烧的5岁以下儿童接受ACT治疗的比例。我们提出了一个改进的指标，纳入了寄生虫感染状态(通过快速诊断测试[RDT]进行评估)，该指标在最近的家庭调查中可用。在这项研究中，我们估计了2003-15年接受ACT治疗的非洲5岁以下发烧和RDT阳性儿童的年度比例。我们的建模研究使用了2003至2015年间撒哈拉以南非洲所有可获得的全国代表性家庭调查(疟疾指标调查、人口与健康调查和多指标群调查)汇编的关于5岁以下儿童发烧治疗和RDT状况的横断面数据。对RDT评估的5岁以下儿童在过去14天内发烧和接受ACT的恶性疟原虫感染的比例的估计被纳入一个通用的加法混合模型，包括ACT分布的数据，以估计所有国家和时间段的覆盖范围。我们进行了随机效应荟萃分析，以检验与ACT覆盖率相关的个人、家庭和社区效应。我们从33个国家和地区的103项调查(22项管理信息系统、61项国土安全部和20项MIC)中获得了201,704名5岁以下儿童的数据。其中40项调查获得了RDT结果，其中包括40 261名(20%)儿童，我们预测了其余161 443名(80%)儿童的RDT状况。我们的结果显示，2003-15年间，撒哈拉以南非洲5岁以下发热和恶性疟原虫感染儿童的ACT覆盖率有所增加，但即使在2015年，也只有19.7%(95%可信区间15.6-24.8)的5岁以下发热和恶性疟原虫感染儿童接受了ACT。在荟萃分析中，如果5岁以下的儿童居住在城市地区(与农村地区相比；优势比[OR]1.18，95%可信区间1.06-1.31)，家庭财富高于全国中位数(与财富低于中位数水平；OR 1.26，1.16-1.39)，有受过任何教育的照顾者(与未受过教育；OR 1.31，1.22-1.41)，有家用驱虫蚊帐(ITN；与没有ITN；或1.21，1.13-1.29)，2岁以上(对≤2岁；OR1.09，1.01-1.17)，或居住在2-10岁儿童恶性疟平均患病率较高的地区(OR1.12，1.02-1.23)。在寻求治疗的儿童亚组中，那些在公共部门寻求治疗的儿童更有可能获得ACT(与私营部门相比；OR 3.18，2.67-3.78)。尽管在2003-15年疟疾方案期间取得了进展，但疟疾儿童的ACT治疗仍然低得令人无法接受。需要在国家一级开展更多工作，以了解如何改进卫生保健服务的获得、服务的提供和ACT的供应，以确保所有疟疾儿童得到适当的治疗。美国总统疟疾倡议和疟疾药物风险投资。
Artemisinin-based combination therapies (ACTs) are the most effective treatment for uncomplicated Plasmodium falciparum malaria infection. A commonly used indicator for monitoring and assessing progress in coverage of malaria treatment is the proportion of children younger than 5 years with reported fever in the previous 14 days who have received an ACT. We propose an improved indicator that incorporates parasite infection status (as assessed by a rapid diagnostic test [RDT]), which is available in recent household surveys. In this study we estimated the annual proportion of children younger than 5 years with fever and a positive RDT in Africa who received an ACT in 2003–15. Our modelling study used cross-sectional data on treatment for fever and RDT status for children younger than 5 years compiled from all nationally available representative household surveys (the Malaria Indicator Surveys, Demographic and Health Surveys, and Multiple Indicator Cluster Surveys) across sub-Saharan Africa between 2003 and 2015. Estimates for the proportion of children younger than 5 years with a fever within the previous 14 days and P falciparum infection assessed by RDT who received an ACT were incorporated in a generalised additive mixed model, including data on ACT distributions, to estimate coverage across all countries and time periods. We did random effects meta-analyses to examine individual, household, and community effects associated with ACT coverage. We obtained data on 201 704 children younger than 5 years from 103 surveys (22 MIS, 61 DHS, and 20 MICS) across 33 countries. RDT results were available for 40 of these surveys including 40 261 (20%) children, and we predicted RDT status for the remaining 161 443 (80%) children. Our results showed that ACT coverage in children younger than 5 years with a fever and P falciparum infection increased across sub-Saharan Africa in 2003–15, but even in 2015, only 19.7% (95% CI 15.6–24.8) of children younger than 5 years with a fever and P falciparum infection received an ACT. In meta-analyses, children younger than 5 years were more likely to receive an ACT for fever and P falciparum infection if they lived in an urban area (vs rural area; odds ratio [OR] 1.18, 95% CI 1.06–1.31), had household wealth above the national median (vs wealth below the median; OR 1.26, 1.16–1.39), had a caregiver with any education (vs no education; OR 1.31, 1.22–1.41), had a household insecticide-treated net (ITN; vs no ITN; OR 1.21, 1.13–1.29), were older than 2 years (vs ≤2 years; OR 1.09, 1.01–1.17), or lived in an area with a higher mean P falciparum prevalence in children aged 2–10 years (OR 1.12, 1.02–1.23). In the subgroup of children for whom treatment was sought, those who sought treatment in the public sector were more likely to receive an ACT (vs the private sector; OR 3.18, 2.67–3.78). Despite progress during the 2003–15 malaria programme, ACT treatment for children with malaria remains unacceptably low. More work is needed at the country level to understand how health-care access, service delivery, and ACT supply might be improved to ensure appropriate treatment for all children with malaria. US President's Malaria Initiative and Medicines for Malaria Venture.