Effect of anti-malarial interventions on trends of malaria cases, hospital admissions and deaths, 2005-2015, Ghana.
Effect of anti-malarial interventions on trends of malaria cases, hospital admissions and deaths, 2005-2015, Ghana.
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DOI：
10.1186/s12936-017-1828-6
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发表时间：
2017-04-26
期刊：
影响因子：
3
通讯作者：
Bart-Plange C
中科院分区：
文献类型：
--
作者：
Aregawi M;Malm KL;Wahjib M;Kofi O;Allotey NK;Yaw PN;Abba-Baffoe W;Segbaya S;Owusu-Antwi F;Kharchi AT;Williams RO;Saalfeld M;Workneh N;Shargie EB;Noor AM;Bart-Plange C
自2005年以来，加纳政府及其伙伴在共同努力控制疟疾方面，扩大了青蒿素综合疗法和驱虫蚊帐的使用。从2011年开始，开展了一场大规模的长效杀虫蚊帐运动，目标是所有人口。使用地区医院的数据评估了这些干预措施对疟疾病例、入院和死亡的影响。回顾了88家医院的疟疾病例和死亡记录以及ACT的可获得性，以及在地区一级的记录、ITN分布和室内残留喷洒。估计了每年可能受到ITN保护的人口比例，假设每个LLIN覆盖1.8人，为期3年。用分段对数线性回归估计了2015年病例和死亡趋势的变化，比较了扩大后(2011-2015年)和扩大前(2005-2010年)期间的趋势。还将基于人口的家庭调查得出的5岁以下儿童死亡率趋势与同期在医院观察到的趋势进行了比较。在所有年龄段中，到2015年上半年(扩大后)与扩大前(2005-2010年)相比，门诊疟疾病例(确诊和推定)数量下降了57%(95%可信区间[CI]，47-66%)。镜检确诊病例减少53%(28-69%)，镜检稳定。试验阳性率(TPR)下降41%(19~57%)。疟疾入院人数变化不大，而疟疾死亡人数大幅下降65%(52%-75%)。在5岁以下儿童中，疟疾门诊病例总数、住院病例和死亡人数分别减少了50%(32-63%)、46%(19-75%)和70%(49-82%)。所有年龄段和五岁以下儿童的疟疾门诊病例、各种原因疾病的住院和死亡比例也大幅下降了3%&30%。在三个流行病层面(沿海、森林、大草原)观察到主要疟疾指标也出现了类似的下降。在国家健康保险计划(NHIS)覆盖的患者中，与未参保的患者相比，全原因入院人数显着增加。同期，非疟疾病例和非疟疾死亡病例增加或保持不变。在家庭调查中，5岁以下儿童的全因死亡率与医院中观察到的死亡率相似，在2008年至2014年期间下降了43%。这些数据提供了令人信服的证据，表明自2011年以来LLIN针对所有年龄段的大规模运动产生了影响，同时保持了其他抗疟疾干预措施。疟疾病例和死亡人数分别下降了50%和65%以上。在五岁以下的儿童中，下降幅度更大。所有年龄段的检测阳性率均下降了40%。疟疾死亡人数的下降是在入院人数增加的背景下进行的，这是因为通过国家卫生保健制度免费获得住院治疗。这项研究表明，基于卫生机构的回溯性数据最大限度地减少了报告偏差，以评估干预措施的效果。加纳的疟疾控制有赖于有效干预措施的持续覆盖，加强监测对于监测这些投资的进展情况至关重要。
Since 2005, the Government of Ghana and its partners, in concerted efforts to control malaria, scaled up the use of artemisinin-based combination therapy (ACT) and insecticide-treated nets (ITNs). Beginning in 2011, a mass campaign of long-lasting insecticidal nets (LLINs) was implemented, targeting all the population. The impact of these interventions on malaria cases, admissions and deaths was assessed using data from district hospitals. Records of malaria cases and deaths and availability of ACT in 88 hospitals, as well as at district level, ITN distribution, and indoor residual spraying were reviewed. Annual proportion of the population potentially protected by ITNs was estimated with the assumption that each LLIN covered 1.8 persons for 3 years. Changes in trends of cases and deaths in 2015 were estimated by segmented log-linear regression, comparing trends in post-scale-up (2011–2015) with that of pre-scale-up (2005–2010) period. Trends of mortality in children under 5 years old from population-based household surveys were also compared with the trends observed in hospitals for the same time period. Among all ages, the number of outpatient malaria cases (confirmed and presumed) declined by 57% (95% confidence interval [CI], 47–66%) by first half of 2015 (during the post-scale-up) compared to the pre-scale-up (2005–2010) period. The number of microscopically confirmed cases decreased by 53% (28–69%) while microscopic testing was stable. Test positivity rate (TPR) decreased by 41% (19–57%). The change in malaria admissions was insignificant while malaria deaths fell significantly by 65% (52–75%). In children under 5 years old, total malaria outpatient cases, admissions and deaths decreased by 50% (32–63%), 46% (19–75%) and 70% (49–82%), respectively. The proportion of outpatient malaria cases, admissions and deaths of all-cause conditions in both all ages and children under five also fell significantly by >30%. Similar decreases in the main malaria indicators were observed in the three epidemiological strata (coastal, forest, savannah). All-cause admissions increased significantly in patients covered by the National Health Insurance Scheme (NHIS) compared to the non-insured. The non-malaria cases and non-malaria deaths increased or remained unchanged during the same period. All-cause mortality for children under 5 years old in household surveys, similar to those observed in the hospitals, declined by 43% between 2008 and 2014. The data provide compelling evidence of impact following LLIN mass campaigns targeting all ages since 2011, while maintaining other anti-malarial interventions. Malaria cases and deaths decreased by over 50 and 65%, respectively. The declines were stronger in children under five. Test positivity rate in all ages decreased by >40%. The decrease in malaria deaths was against a backdrop of increased admissions owing to free access to hospitalization through the NHIS. The study demonstrated that retrospective health facility-based data minimize reporting biases to assess effect of interventions. Malaria control in Ghana is dependent on sustained coverage of effective interventions and strengthened surveillance is vital to monitor progress of these investments.