The long road to elimination: malaria mortality in a South African population cohort over 21 years.
The long road to elimination: malaria mortality in a South African population cohort over 21 years.
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DOI：
10.1017/gheg.2017.7
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Kahn K
中科院分区：
文献类型：
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作者：
Byass P;Collinson MA;Kabudula C;Gómez-Olivé FX;Wagner RG;Ngobeni S;Silaule B;Mee P;Coetzee M;Twine W;Tollman SM;Kahn K
在成功减少传播之后，消灭疟疾已列入全球议程。然而，从低传输到零传输是具有挑战性的。南非的消灭目标是2018年，在其低流行地区可能实现，也可能实现不了。阿金库尔卫生和人口监测系统自1992年以来一直监测南非东北部的人口健康状况。对21年期间疟疾死亡的个人因素、社会经济地位、劳动力迁移和天气进行了分析，得出了一段时间内的趋势以及与协变量的关联。在158万人年的13251例登记死亡中，1.2%归因于疟疾。从1992年到2013年，疟疾死亡率有所上升，而平均日最高气温上升了1.5 °C。前往疟疾流行的莫桑比克变得更加容易，社会经济地位较高的群体的疟疾死亡率上升。总体而言，疟疾死亡率与年龄、社会经济地位、劳动力迁移和就业、年降雨量和死亡前不久较高的降雨量/温度显著相关。疟疾仍然是南非半农村人口的一个小但重要的死亡原因。详细的纵向人口数据对这些分析至关重要。研究结果强调了在从低传播情景转向消除疟疾的过程中，其他地方也可能遇到的实际政治、社会经济和环境困难。
Malaria elimination is on global agendas following successful transmission reductions. Nevertheless moving from low to zero transmission is challenging. South Africa has an elimination target of 2018, which may or may not be realised in its hypoendemic areas. The Agincourt Health and Demographic Surveillance System has monitored population health in north-eastern South Africa since 1992. Malaria deaths were analysed against individual factors, socioeconomic status, labour migration and weather over a 21-year period, eliciting trends over time and associations with covariates. Of 13 251 registered deaths over 1.58 million person-years, 1.2% were attributed to malaria. Malaria mortality rates increased from 1992 to 2013, while mean daily maximum temperature rose by 1.5 °C. Travel to endemic Mozambique became easier, and malaria mortality increased in higher socioeconomic groups. Overall, malaria mortality was significantly associated with age, socioeconomic status, labour migration and employment, yearly rainfall and higher rainfall/temperature shortly before death. Malaria persists as a small but important cause of death in this semi-rural South African population. Detailed longitudinal population data were crucial for these analyses. The findings highlight practical political, socioeconomic and environmental difficulties that may also be encountered elsewhere in moving from low-transmission scenarios to malaria elimination.