The age patterns of severe malaria syndromes in sub-Saharan Africa across a range of transmission intensities and seasonality settings
The age patterns of severe malaria syndromes in sub-Saharan Africa across a range of transmission intensities and seasonality settings
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DOI：
10.1186/1475-2875-9-282
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发表时间：
2010-10-13
期刊：
影响因子：
3
通讯作者：
Schellenberg, David
中科院分区：
文献类型：
--
作者：
Roca-Feltrer, Arantxa;Carneiro, Ilona;Schellenberg, David
背景资料：需要更好地了解疟疾的传播强度、季节性和年龄模式之间的关系，以指导在不同流行病背景下适当确定疟疾干预措施的目标。研究方法：一项系统性文献综述确定了报告脑型疟疾（CM）、重度疟疾性贫血（SMA）或呼吸窘迫（RD）儿童住院年龄的研究。研究地点被归类为恶性疟原虫传播强度和季节性的3x2矩阵。概率分布采用最大似然法拟合，最佳拟合模型用于估计中位年龄，并以图形方式表示矩阵中每个传播类别的每个结局的年龄模式。结果如下：随着传播强度的增加，观察到CM的负担向年轻年龄组转移，但SMA或RD的情况并非如此。与所有三种严重疟疾综合征的“明显季节性”地区相比，“无明显季节性”地区显示出更多的年龄模式偏斜的证据。结论：虽然CM的高峰年龄将随着非洲传播强度的降低而增加，但在大多数流行病学环境中，超过75%的重症疟疾儿科住院病例可能仍在5奥尔兹以下。
Background: A greater understanding of the relationship between transmission intensity, seasonality and the age-pattern of malaria is needed to guide appropriate targeting of malaria interventions in different epidemiological settings. Methods: A systematic literature review identified studies which reported the age of paediatric hospital admissions with cerebral malaria (CM), severe malarial anaemia (SMA), or respiratory distress (RD). Study sites were categorized into a 3 x 2 matrix of Plasmodium falciparum transmission intensity and seasonality. Probability distributions were fitted by maximum likelihood methods, and best fitting models were used to estimate median ages and to represent graphically the age-pattern of each outcome for each transmission category in the matrix. Results: A shift in the burden of CM towards younger age groups was seen with increasing intensity of transmission, but this was not the case for SMA or RD. Sites with 'no marked seasonality' showed more evidence of skewed age-patterns compared to areas of 'marked seasonality' for all three severe malaria syndromes. Conclusions: Although the peak age of CM will increase as transmission intensity decreases in Africa, more than 75% of all paediatric hospital admissions of severe malaria are likely to remain in under five year olds in most epidemiological settings.