Impact of seasonal malaria chemoprevention on hospital admissions and mortality in children under 5 years of age in Ouelessebougou, Mali
Impact of seasonal malaria chemoprevention on hospital admissions and mortality in children under 5 years of age in Ouelessebougou, Mali
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DOI：
10.1186/s12936-020-03175-y
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发表时间：
2020-03-03
期刊：
影响因子：
3
通讯作者：
Dicko, Alassane
中科院分区：
文献类型：
--
作者：
Issiaka, Djibrilla;Barry, Amadou;Dicko, Alassane
季节性疟疾化学预防在非洲萨赫勒和萨赫勒以南国家广泛实施。很少有研究评估SMC在卫生系统中实施时对住院和死亡的影响。这项回顾性研究评估了季节性疟疾化学预防（SMC）在马里Ouelessebougou卫生区实施SMC的第二年对5岁以下儿童住院和死亡的影响。方法2017年2月，进行了一项调查，以评估2015年实施SMC的两个卫生分区和未实施SMC的两个卫生分区5岁以下儿童的住院和死亡情况。调查审查了四个卫生分区5岁以下儿童的死亡和住院情况。在两组中确定住院和死亡的粗发病率和特定发病率，并表示为每年每1000名儿童。采用负二项回归模型和考克斯模型估计调整混杂因素后住院和死亡的相对风险。采用R软件进行数据分析。结果共调查6 638名5岁以下儿童，干预区2 759名，对照区3 879名。对照区的全因死亡率为8.29/1000人-年，而干预区为3.63/1000人-年;年龄和性别调整的死亡率比为0.44（95% CI 0.22-0.91），p = 0.027。干预组全因住院的发生率为19.60/1000人-年，对照组为33.45/1000人-年，经年龄和性别校正的发生率比（IRR）为0.61（95% CI 0.44-0.84），p = 0.003。结论SMC的实施与住院率和全因死亡率的大幅降低有关。试用注册ClinicalTrials.gov NCT 02646410。
Background Seasonal malaria chemoprevention is widely implemented in Sahel and sub-Sahel countries in Africa. Few studies have assessed the impact of the SMC on hospital admission and death when it is implemented in the health system. This retrospective study assessed the impact of seasonal malaria chemoprevention (SMC) on hospitalizations and deaths of children under 5 years of age during the second year of implementation of SMC in the health district of Ouelessebougou in Mali. Methods In February 2017, a survey was conducted to assess hospital admissions and deaths in children under 5 years of age in two health sub-districts where SMC was implemented in 2015 and two health sub-districts where SMC was not implemented. The survey reviewed deaths and hospitalizations of children under 5, in the four health sub-districts. The crude and specific incidence rates of hospitalizations and deaths were determined in both groups and expressed per 1000 children per year. A negative binomial regression model and a Cox model were used to estimate the relative risks of hospitalization and death after adjusting for confounders. The R software was used for data analysis. Results A total of 6638 children under 5 years of age were surveyed, 2759 children in the SMC intervention areas and 3879 children in the control areas. All causes mortality rate per 1000 person-years was 8.29 in the control areas compared to 3.63 in the intervention areas; age and gender adjusted mortality rate ratio 0.44 (95% CI 0.22-0.91), p = 0.027. The incidence rate of all causes hospital admissions was 19.60 per 1000 person-years in the intervention group compared to 33.45 per 1000 person-years in the control group, giving an incidence rate ratio (IRR) adjusted for age and gender of 0.61 (95% CI 0.44-0.84), p = 0.003. Conclusion The implementation of SMC was associated with a substantial reduction in hospital admissions and all-cause mortality. Trial registration ClinicalTrials.gov NCT02646410.