Impact evaluation of malaria control interventions on morbidity and all-cause child mortality in Mali, 2000-2012.
Impact evaluation of malaria control interventions on morbidity and all-cause child mortality in Mali, 2000-2012.
复制标题
DOI：
10.1186/s12936-018-2573-1
复制
发表时间：
2018-11-14
期刊：
影响因子：
3
通讯作者：
Eckert E
中科院分区：
文献类型：
--
作者：
Kayentao K;Florey LS;Mihigo J;Doumbia A;Diallo A;Koné D;Doumbo O;Eckert E
自2001年以来进行了重大投资，2006年后加强了疟疾控制干预措施。干预措施包括向孕妇和5岁以下儿童免费分发驱虫蚊帐，采用青蒿素综合疗法治疗疟疾，以及室内滞留喷洒杀虫剂。资助者包括马里政府、全球抗击艾滋病、结核病和疟疾基金以及美国总统疟疾倡议。2000年至2015年进行的全国代表性家庭调查的数据用于对疟疾干预覆盖率、5岁以下儿童发病率[寄生虫血症和严重贫血（< 8 g/dl）]和5岁以下儿童全因死亡率（ACCM）进行趋势分析。还评估了可能导致ACCM的背景因素的患病率。使用可接受性论证评估了这些干预措施对疟疾发病率和死亡率的影响。假设在疟疾传播率高的环境中，疟疾是五岁以下儿童死亡率的主要原因，在考虑到与儿童生存有关的其他背景因素的情况下，对疟疾控制干预措施与五岁以下儿童全因死亡率之间的关联进行了评估。从2006年到2012年，干预措施的覆盖率显著提高。驱虫蚊帐的家庭拥有率从2006年的49%上升到2012年的84%。在同一时期，5岁以下儿童使用驱虫蚊帐的比例从2006年的26%上升到2012年的69%，孕妇使用驱虫蚊帐的比例从2006年的28%上升到2012年的73%。使用两剂或两剂以上SP的妊娠期间歇性预防性治疗的覆盖率从2006年的10%增加到2012年的29%。2010年，23%的5岁以下发热儿童接受了ACT治疗，而2012年为19%。恶性疟原虫感染的患病率从2010年（38.6%）上升到2012年（51.6%），随后在2015年下降（35.8%）。严重贫血的患病率从2010年（26.3%）下降到2012年（20.6%），并在2015年继续下降（19.9%）。ACCM的下降幅度令人印象深刻，从1997-2001年的225起下降到2002-2006年的192起和2008-2012年的95起。在评估期间，气候、社会经济、营养和妇幼保健干预措施覆盖面等背景因素的变化不利于ACCM的减少，因此不太可能解释观察到的结果。总体而言，证据支持以下结论：疟疾控制干预措施在很大程度上促成了2000年至2012年马里ACCM的下降，即使在气候变化和政治不稳定等背景因素解释的寄生虫病持续高流行的情况下。
Major investments have been made since 2001, with intensification of malaria control interventions after 2006. Interventions included free distribution of insecticide-treated nets (ITN) to pregnant women and children under 5 years old, the introduction of artemisinin combination therapy (ACT) for malaria treatment, and indoor residual spraying of insecticides. Funders include the Government of Mali, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the US President’s Malaria Initiative. Data from nationally representative household surveys conducted from 2000 to 2015 was used to performed the trend analysis for malaria intervention coverage, prevalence of morbidities among children under 5 years old [parasitemia and severe anaemia (< 8 g/dl)], and all-cause mortality of children under 5 (ACCM). Prevalence of contextual factors likely to contribute to ACCM were also assessed. The impact of these interventions was assessed on malaria morbidity and mortality using a plausibility argument. With the assumption that malaria contributes significantly to under-five mortality in settings with high malaria transmission, associations between malaria control interventions and all-cause under-five mortality (ACCM) were assessed taking into account other contextual factors related to child survival. Intervention coverage improved significantly from 2006 to 2012. Household ownership of ITN increased from 49% in 2006 to 84% in 2012. ITN use also increased over the same period, from 26% in 2006 to 69% in 2012 among children under 5 and from 28% in 2006 to 73% in 2012 among pregnant women. The coverage of intermittent preventive treatment in pregnancy (IPTp) using two or more doses of SP increased from 10% in 2006 to 29% in 2012. In 2010, 23% of febrile children under 5 received ACT, as opposed to 19% in 2012. The prevalence of Plasmodium falciparum infection increased from 2010 (38.6%) to 2012 (51.6%), followed by a decrease in 2015 (35.8%). The prevalence of severe anaemia decreased from 2010 (26.3%) to 2012 (20.6%) and continued to decline in 2015 (19.9%). An impressive decline in ACCM was observed, from 225 in 1997–2001 to 192 in 2002–2006 and 95 in 2008–2012. Changes in contextual factors such as climate, socio-economic, nutrition, and coverage of maternal and child health interventions over the evaluation period did not favour reductions in ACCM, and are therefore unlikely to explain the observed results. Taken as a whole, the evidence supports the conclusion that malaria control interventions substantially contributed to the observed decline in ACCM in Mali from 2000 to 2012, even in the context of continued high prevalence of parasitaemia explained by contextual factors such as climate change and political instability.
登录
查看更多内容
影响因子：
3
作者：
Sogoba, Nafomon;Vounatsou, Penelope;Toure, Yeya T.
通讯作者：
Toure, Yeya T.
影响因子：
3
作者：
Gething PW;Patil AP;Smith DL;Guerra CA;Elyazar IR;Johnston GL;Tatem AJ;Hay SI
通讯作者：
Hay SI
影响因子：
3.3
作者：
Eckert, Erin;Florey, Lia S.;Karema, Corine
通讯作者：
Karema, Corine
影响因子：
3.3
作者：
Thwing, Julie;Eckert, Erin;Ba, Mady
通讯作者：
Ba, Mady
影响因子：
3.3
作者：
Vega, Juan Carlos;Sanchez, Boris Fernando;Reithinger, Richard
通讯作者：
Reithinger, Richard