Stable malaria incidence despite scaling up control strategies in a malaria vaccine-testing site in Mali
Stable malaria incidence despite scaling up control strategies in a malaria vaccine-testing site in Mali
复制标题
DOI：
10.1186/1475-2875-13-374
复制
发表时间：
2014-09-19
期刊：
影响因子：
3
通讯作者：
Thera, Mahamadou A.
中科院分区：
文献类型：
--
作者：
Coulibaly, Drissa;Travassos, Mark A.;Thera, Mahamadou A.
背景：许多非洲国家最近疟疾发病率的下降归因于使用青蒿素联合疗法（ACT）提供及时有效的抗疟疾治疗以及广泛分发长效、杀虫剂处理的蚊帐（LLIN）。马里班迪亚加拉的疟疾疫苗测试点于 2004 年推出了 ACT，自 2007 年起，向完成扩大免疫计划 (EPI) 计划的婴儿和接受产前护理的孕妇免费分发 LLIN。这些策略可能对疟疾发病率产生影响。方法：为了记录疟疾发病率，截至 2013 年 7 月，对 400 名 0 至 14 岁儿童进行了为期三至四年的跟踪调查。每月进行横断面调查，以衡量疟疾感染和贫血的患病率。通过持续提供初级医疗保健，可以主动和被动地测量临床疾病。测量的结果包括无症状疟原虫感染、贫血和临床疟疾发作。结果：2009年6月至2013年7月临床疟疾的发病率变化很大，但没有明显的下降趋势。疟疾发病具有明显的季节性，雨季临床疟疾发病率较高。寄生虫和贫血点的患病率也表现出季节性变化，与旱季相比，雨季的患病率要高得多。结论：尽管在研究期间，班贾加拉的疟疾预防和治疗规模有所扩大，包括广泛使用蚊帐、更好的诊断和更广泛地使用 ACT，但疟疾发病率并未下降。
Background: The recent decline in malaria incidence in many African countries has been attributed to the provision of prompt and effective anti-malarial treatment using artemisinin-based combination therapy (ACT) and to the widespread distribution of long-lasting, insecticide-treated bed nets (LLINs). At a malaria vaccine-testing site in Bandiagara, Mali, ACT was introduced in 2004, and LLINs have been distributed free of charge since 2007 to infants after they complete the Expanded Programme of Immunization (EPI) schedule and to pregnant women receiving antenatal care. These strategies may have an impact on malaria incidence.Methods: To document malaria incidence, a cohort of 400 children aged 0 to 14 years was followed for three to four years up to July 2013. Monthly cross-sectional surveys were done to measure the prevalence of malaria infection and anaemia. Clinical disease was measured both actively and passively through continuous availability of primary medical care. Measured outcomes included asymptomatic Plasmodium infection, anaemia and clinical malaria episodes.Results: The incidence rate of clinical malaria varied significantly from June 2009 to July 2013 without a clear downward trend. A sharp seasonality in malaria illness incidence was observed with higher clinical malaria incidence rates during the rainy season. Parasite and anaemia point prevalence also showed seasonal variation with much higher prevalence rates during rainy seasons compared to dry seasons.Conclusions: Despite the scaling up of malaria prevention and treatment, including the widespread use of bed nets, better diagnosis and wider availability of ACT, malaria incidence did not decrease in Bandiagara during the study period.