The Relative Role of Climate Variation and Control Interventions on Malaria Elimination Efforts in El Oro, Ecuador: A Modeling Study
The Relative Role of Climate Variation and Control Interventions on Malaria Elimination Efforts in El Oro, Ecuador: A Modeling Study
复制标题
DOI：
10.3389/fenvs.2020.00135
复制
发表时间：
2020-08-27
影响因子：
4.6
通讯作者：
Lowe, Rachel
中科院分区：
文献类型：
--
作者：
Fletcher, Isabel K.;Stewart-Ibarra, Anna M.;Lowe, Rachel
疟疾是一种病媒传播的疾病，引起重大公共卫生关切。尽管许多消除行动取得了广泛的成功，但世界上一些地区的消除努力却停滞不前。消除疟疾的障碍包括气候和土地使用的变化，如气温升高和城市化，这可能会改变蚊子的栖息地。政治不稳定和区域移徙等社会经济因素也威胁到消除目标。这一点在已经实现局部消灭的地区尤其重要，因此监测和控制工作正在减少，不再是优先事项。了解环境变化如何影响消灭疟疾对病媒控制和疾病监测战略具有重要的实际意义。在监测疟疾因社会经济影响而死灰复燃的威胁时，必须考虑到气候变化。然而，对气候变化、干预措施和社会经济压力如何共同影响疟疾传播和消除工作的长期趋势的评估有限。在这项研究中，我们使用贝叶斯分层混合模型和29年的疟疾病例数据，以解开气候变化和疟疾控制工作对厄瓜多尔埃尔奥罗省疟疾风险的影响，该省于2011年实现了当地消除。我们发现疟疾的模式在农村和城市地区之间发生了变化，城市化地区的间日疟原虫相对增加。最低温度是疟疾季节性的重要驱动因素，与P.间日疟有相当大的异质性的影响，三种化学媒介控制措施对bothP。恶性疟原虫和P.间日疟我们发现三种措施中的两种[室内滞留喷洒和空间喷洒]与疟疾发病率的降低之间存在统计学显著相关性，这种相关性因疟疾类型而异。我们还发现，埃尔奥罗的疟疾传播环境适宜性正在增加，如果允许疟疾重新建立，这可能会限制未来的消除努力。我们的研究结果对于理解消除疟疾的环境障碍具有重要意义，并强调了在仍然容易死灰复燃的地区设计和维持消除工作的重要性。
Malaria is a vector-borne disease of significant public health concern. Despite widespread success of many elimination initiatives, elimination efforts in some regions of the world have stalled. Barriers to malaria elimination include climate and land use changes, such as warming temperatures and urbanization, which can alter mosquito habitats. Socioeconomic factors, such as political instability and regional migration, also threaten elimination goals. This is particularly relevant in areas where local elimination has been achieved and consequently surveillance and control efforts are dwindling and are no longer a priority. Understanding how environmental change, impacts malaria elimination has important practical implications for vector control and disease surveillance strategies. It is important to consider climate change when monitoring the threat of malaria resurgence due to socioeconomic influences. However, there is limited assessment of how the combination of climate variation, interventions and socioeconomic pressures influence long-term trends in malaria transmission and elimination efforts. In this study, we used Bayesian hierarchical mixed models and malaria case data for a 29-year period to disentangle the impacts of climate variation and malaria control efforts on malaria risk in the Ecuadorian province of El Oro, which achieved local elimination in 2011. We found shifting patterns of malaria between rural and urban areas, with a relative increase ofPlasmodium vivaxin urbanized areas. Minimum temperature was an important driver of malaria seasonality and the association between warmer minimum temperatures and malaria incidence was greater forPlasmodium falciparumcompared toP. vivaxmalaria. There was considerable heterogeneity in the impact of three chemical vector control measures on bothP. falciparumandP. vivaxmalaria. We found statistically significant associations between two of the three measures [indoor residual spraying (IRS) and space spraying] and a reduction in malaria incidence, which varied between malaria type. We also found environmental suitability for malaria transmission is increasing in El Oro, which could limit future elimination efforts if malaria is allowed to re-establish. Our findings have important implications for understanding environmental obstacles to malaria elimination and highlights the importance of designing and sustaining elimination efforts in areas that remain vulnerable to resurgence.