Fever treatment in the absence of malaria transmission in an urban informal settlement in Nairobi, Kenya
Fever treatment in the absence of malaria transmission in an urban informal settlement in Nairobi, Kenya
复制标题
DOI：
10.1186/1475-2875-8-160
复制
发表时间：
2009-07-15
期刊：
影响因子：
3
通讯作者：
Snow, Robert W.
中科院分区：
文献类型：
--
作者：
Ye, Yazoume;Madise, Nyovani;Snow, Robert W.
背景：在撒哈拉以南非洲，关于疟疾在迅速扩散的城市中心传播的知识和预防或管理疟疾的建议仍然不明确。这篇论文提出了一项调查的结果感染流行和治疗最近的发热事件在内罗毕，肯尼亚贫民窟人口。方法：2008年7月，在科罗戈乔贫民窟进行了基于社区的疟疾寄生虫流行率调查，这是内罗毕城市健康和人口监测系统的一部分。采访者在家中访问了1,069名参与者，并收集了过去14天内报告发烧的数据以及这些发作的治疗细节。使用快速诊断试验（RDT）和显微镜检查每位参与者是否存在疟原虫。进行描述性分析以评估报告的发烧发作和治疗行为的期间患病率。结果：在访问的1,069名参与者中，983名（92%）同意接受测试。3例恶性疟原虫RDT阳性；然而，显微镜检查均为阴性。所有953张可读载玻片的显微镜检查显示患病率为零。总体而言，从1004名有发热数据的参与者中，报告了170次发热发作，期间患病率相对较高（16.9%,95% CI: 13.9%-20.5%），五岁以下儿童的患病率更高（20.1%,95% CI: 13.8%-27.8%）。在有治疗信息的发热发作中，54.3%（95%置信区间：46.3%-62.2%）作为疟疾治疗，主要使用磺胺嘧啶-乙胺嘧啶或阿莫地喹，包括那些在正规卫生机构管理的发热发作。只有4次发作使用了国家推荐的一线治疗方法，蒿甲醚-氟苯曲明。结论：这项研究不能证明在内罗毕中心的一个贫民窟Korogocho存在疟疾的任何证据。发烧是一种常见的症状，通常用抗疟疾药物作为疟疾治疗。地区规划人员应该优先考虑一些战略，包括检测疟疾寄生虫，以减少贫困社区不适当地接触临床服务机构和药品供应商提供的昂贵抗疟疾药物。
Background: In sub-Saharan Africa, knowledge of malaria transmission across rapidly proliferating urban centres and recommendations for its prevention or management remain poorly defined. This paper presents the results of an investigation into infection prevalence and treatment of recent febrile events among a slum population in Nairobi, Kenya.Methods: In July 2008, a community-based malaria parasite prevalence survey was conducted in Korogocho slum, which forms part of the Nairobi Urban Health and Demographic Surveillance system. Interviewers visited 1,069 participants at home and collected data on reported fevers experienced over the preceding 14 days and details on the treatment of these episodes. Each participant was tested for malaria parasite presence with Rapid Diagnostic Test (RDT) and microscopy. Descriptive analyses were performed to assess the period prevalence of reported fever episodes and treatment behaviour.Results: Of the 1,069 participants visited, 983 (92%) consented to be tested. Three were positive for Plasmodium falciparum using RDT; however, all were confirmed negative on microscopy. Microscopic examination of all 953 readable slides showed zero prevalence. Overall, from the 1,004 participants who have data on fever, 170 fever episodes were reported giving a relatively high period prevalence (16.9%, 95% CI: 13.9%-20.5%) and higher among children below five years (20.1%, 95% CI: 13.8%-27.8%). Of the fever episodes with treatment information 54.3% ( 95% CI: 46.3%-62.2%) were treated as malaria using mainly sulphadoxine-pyrimethamine or amodiaquine, including those managed at a formal health facility. Only four episodes were managed using the nationally recommended first-line treatment, artemether-lumefantrine.Conclusion: The study could not demonstrate any evidence of malaria in Korogocho, a slum in the centre of Nairobi. Fever was a common complaint and often treated as malaria with anti-malarial drugs. Strategies, including testing for malaria parasites to reduce the inappropriate exposure of poor communities to expensive anti-malarial drugs provided by clinical services and drug vendors, should be a priority for district planners.