No evidence of decline in malaria burden from 2006 to 2013 in a rural Province of Gabon: implications for public health policy.
No evidence of decline in malaria burden from 2006 to 2013 in a rural Province of Gabon: implications for public health policy.
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DOI：
10.1186/s12889-015-1456-4
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发表时间：
2015-02-04
影响因子：
4.5
通讯作者：
Fandeur T
中科院分区：
文献类型：
--
作者：
Assele V;Ndoh GE;Nkoghe D;Fandeur T
2000年至2008年期间，加蓬城市地区的疟疾发病率稳步下降，但在将这一趋势推广到全国之前应谨慎行事，因为这一发现尚未在偏远农村省份得到系统证实。我们使用2006年至2013年期间在Makokou卫生设施记录的加蓬东北部疟疾病例数据进行了回顾性调查。疟疾数据进行了分析，并与年度变化和患者年龄的关联进行了评估。在研究期间，观察到全球疟疾临床病例和确诊病例有所增加。0至4岁儿童的感染率明显高于5岁及以上儿童和成人。与以前在加蓬城市和半城市地区观察到的情况相反，奥果韦-伊温多省Makokou的疟疾负担在过去8年中基本保持不变，甚至有所增加。恶性疟原虫在加蓬农村地区持续传播的持续性可能与关键干预措施的覆盖面不足、寻求治疗的行为不佳和/或治疗效果下降有关。我们的研究结果强调，需要更好地适应当地的流行病学背景和环境限制的疟疾控制策略。公平地向难以接触到的人口提供保健服务是加蓬卫生当局面临的一个挑战性问题。本文的在线版本（doi：10.1186/s12889-015-1456-4）包含补充材料，可供授权用户使用。
The morbidity of malaria has steady declined in the urban regions of Gabon between 2000 and 2008, but caution should be exercised before generalizing this trend to the whole country because this finding has not been systematically confirmed in remote rural provinces. We conducted a retrospective survey using data on malaria cases recorded in North Eastern Gabon between 2006 and 2013 at health facilities in Makokou. Malaria data were analyzed, and associations with annual variations and patient age were assessed. A global increase in clinical and confirmed malaria cases was observed over the study period. The rate of infection was significantly higher in children aged between 0 to 4 years than in children of 5 years and above, and in adults. Contrary to prior observations in urban and semi-urban areas of Gabon, malaria burden remained mostly unchanged or even increased in Makokou in the Ogooué-Ivindo province during these last 8 years. The persistence of Plasmodium falciparum pockets of sustained malaria transmission in rural Gabon may be related to an inadequate coverage of key interventions, to poor treatment seeking behavior and/or to a decline efficacy of treatments. Our results highlight the need to better adapt malaria control strategies to local epidemiological contexts and to environmental constraints. Equitable delivery of health service to hard-to-reach populations constitutes a challenging issue for the health authorities of Gabon. The online version of this article (doi:10.1186/s12889-015-1456-4) contains supplementary material, which is available to authorized users.
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